胰颈直线切割闭合加连续单层胰肠吻合在胰十二指肠切除术中的应用研究

Use of primary continuous single-layer pancreaticojejunostomy after linear stapler closure of pancreatic remnants in pancreaticoduodenectomy

目的探讨胰颈直线切割闭合加连续单层胰肠吻合在胰十二指肠切除术(PD)中的应用价值。方法回顾性分析2022年2月至5月首都医科大学附属北京朝阳医院西院、日照市肝胆胰脾外科研究所、滨州市第二人民医院和朝阳市中心医院应用胰颈直线切割闭合加连续单层胰肠吻合治疗的21例PD患者资料,其中男性12例,女性9例,年龄范围31.0~82.0岁,中位年龄63.0岁。分析胰颈直线切割闭合成功率、胰肠吻合时间、术后并发症、胰瘘风险评分、住院时间等。结果21例患者中开腹PD 3例,腹腔镜PD 18例,均顺利完成胰颈直线切割闭合加连续单层胰肠吻合,成功率100.0%。在胰腺残端寻找胰管并插入引流管的成功率为100.0%(21/21),其中有3例(14.3%)在残胰断端可见明显的胰管断端。3例开腹PD患者手术时间分别为220.0、245.0、260.0 min,胰肠吻合时间为12.0、13.0、12.0 min,术中出血量为300.0、450.0、600.0 ml,住院时间为14.0、15.0、21.0 d。18例腹腔镜PD患者手术时间为(295.9±14.5)min,胰肠吻合时间为(22.3±1.5)min,术中出血量为(180.0±40.0)ml,住院时间(范围)为8.0~16.0 d,中位数10.5 d。21例患者胰瘘风险评分为(4.7±1.5)分。3例(14.3%)发生术后急性胰腺炎,4例(19.0%)发生胃排空延迟,保守治疗后痊愈。21例患者均无术后出血、院内感染,无B、C级术后胰瘘,无围手术期死亡。结论胰颈直线切割闭合后连续单层胰肠吻合具有质量可靠、操作简单易行等特点,具有预防临床相关术后胰瘘及胰肠吻合口出血的潜质,值得谨慎推广应用。

Objective To study the use of primary continuous single-layer pancreaticojejunostomy after linear stapler closure of pancreatic neck in pancreaticoduodenectomy(PD).Methods The clinical data of 21 patients who were treated with primary continuous single-layer pancreaticojejunostomy after linear stapler closure of pancreatic neck in PD at Beijing Chaoyang Hospital Affiliated,West Campus,Capital Medical University,Rizhao Hepatobiliary-pancreatic-splenic Surgery Research Institute,Binzhou Second People’s Hospital,Chaoyang Central Hospital from February 2022 to May 2022 were retrospectively analyzed.There were 12 males and 9 females,with ages ranging from 31.0 to 82.0 years(median age 63.0 years).The success rates of linear stapling at pancreatic neck,time of pancreaticojejunostomy,postoperative complications,pancreatic fistula risk score,and length of hospital stay were studied.Results Among the 21 patients,there were 3 patients who underwent open PD and 18 patients who underwent laparoscopic PD.Primary continuous single-layer pancreaticojejunostomy after linear stapler closure of pancreatic neck was successfully carried out in all these patients.The success rate was 100.0%.The success rate of finding pancreatic ducts at the pancreatic stumps and inserting an drainage tube was 100.0%(21/21).In the 3 patients who underwent open PD,the operation time were 230.0,245.0 and 250.0 minutes respectively.The time for completing pancreaticojejunostomy were 12.0,13.0 and 12.0 minutes respectively.The estimated blood loss were 300.0,450.0 and 600.0 ml respectively.The length of hospital stay were 14.0,15.0 and 21.0 days.In the 18 patients who underwent laparoscopic PD,the operation time was(295.9±14.5)min,the time for constructing pancreaticojejunostomy was(22.3±1.5)min,the blood loss was(180.0±40.0)ml,the length of hospital stay ranging from 8.0 to 16.0 days(median 10.5 days).Among all the 21 patients,the pancreatic fistula risk score was(4.7±1.5).Postoperative acute pancreatitis occurred in 3 patients(14.3%),delayed gastric emptying occurred in 4 patients(19.0%),and all of them recovered after conservative treatment.There was no postoperative bleeding,nosocomial infection,grade B and C postoperative pancreatic fistula or perioperative death.Conclusion The continuous single-layer pancreaticojejunostomy after linear stapler closure of the pancreatic neck was safe,reliable,simple and technically easy.It has the potential to prevent clinical postoperative pancreatic fistula and pancreaticojejunostomy bleeding.It is worth to popularize this surgical procedure.