LPD胰肠吻合方式现状暨胰腺捆绑交锁式胰肠端侧吻合术式介绍

Status of pancreato-enterostomy of laparoscopic pancreaticoduodenectomy and introduction ofend-to-side pancreaticojejunostomy with pancreatic binding and interlocking

随着腹腔镜技术的发展,腹腔镜胰十二指肠切除术越来越流行。其中胰腺残端的重建是该术式的难点和重点,与术后胰瘘等一系列并发症的发生直接相关。目前胰腺残端重建的方式有很多,但没有一种方法可以完全避免胰瘘的发生。接下来的文章中,笔者将先回顾胰肠吻合的发展历程,然后结合本团队的手术心得谈谈几种常用的胰肠吻合方式的优点与不足,再介绍本团队设计和使用的一种新的胰肠吻合方法,即胰腺捆绑交锁式胰肠端侧吻合术式,最后再讨论胰肠吻合未来发展的一些方向。本文旨在帮助临床医师熟悉胰肠吻合的各种方法,了解每种方法对应的较为合适的使用场景,从而帮助临床医师在手术时作出更加适宜的决策,进而减少术后并发症,改善患者预后。

With the development of laparoscopic techniques,laparoscopic pancreaticoduodenectomy has been widely applied.Reconstruction of the pancreatic stump is the challenging and key step of this procedure,which is directly associated with the occurrence of a series of complications,such as postoperative pancreatic fistula,etc.At present,multiple approaches have been employed to reconstruct pancreatic stump,whereas none of these procedures can completely avoid the incidence of pancreatic fistula.In this article,the development of pancreaticojejunostomy was reviewed,and the advantages and disadvantages of common pancreaticojejunostomy patterns were illustrated based on our surgical experience.Subsequently,a novel pancreaticojejunostomy pattern designed and employed by our team was introduced,namely,the end-to-side pancreaticojejunostomy with pancreatic binding and interlocking,and the future development of pancreaticojejunostomy were finally discussed.This study aims to help clinicians to be familiar with different patterns of pancreaticojejunostomy,and understand appropriate application scenarios of each approach,thereby assisting clinicians to make more appropriate surgical decisions,reduce the risk of postoperative complications and improve clinical prognosis of patients.