[1]袁俊建* 柴伟.改进胰肠吻合法在3D腹腔镜胰十二指肠切除术中的应用[J].中国微创外科杂志,2023,01(9):662-667.
　Yuan Junjian,Chai Wei..Application of Modified Pancreaticojejunostomy in 3D Laparoscopic Pancreaticoduodenectomy[J].Chinese Journal of Minimally Invasive Surgery,2023,01(9):662-667.
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改进胰肠吻合法在3D腹腔镜胰十二指肠切除术中的应用()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2023年9期
页码:
662-667
栏目:
临床研究
出版日期:
2023-09-25

文章信息/Info

Title:
Application of Modified Pancreaticojejunostomy in 3D Laparoscopic Pancreaticoduodenectomy
作者:
袁俊建* 柴伟
(河北省沧州市中心医院肝胆胰外一科，沧州061000)
Author(s):
Yuan Junjian;  Chai Wei.
Department of Hepatobiliary and Pancreatic Surgery Ⅰ, Cangzhou Central Hospital, Cangzhou 061000, China
关键词:
3D腹腔镜; 胰十二指肠切除术; 胰肠吻合; 胰漏
Keywords:
3D laparoscope; Pancreatoduodenectomy; Pancreaticojejunostomy; Pancreatic leakage
文献标志码:
A
摘要:
目的探讨改进胰肠吻合法在3D腹腔镜胰十二指肠切除术(laparoscopic pancreaticoduodenectomy，LPD)胰肠吻合中的应用价值。方法2020年1月~2022年7月我科在62例3D LPD术中应用改进胰肠吻合方式：间断贯穿缝合胰腺断面，按“洪氏一针法”固定胰管内引流管，单针Prolene线对胰腺断面及空肠前后壁两层连续缝合。结果62例均施行3D腹腔镜下完成标本切除及消化道重建。手术时间(247.1±30.2)min，胰肠吻合时间(12.6±4.7)min，术中出血量(189±66)ml。术后住院时间(12.3±4.7)d。术后发生A级生化漏59例(95.2％)，B级胰漏3例(4.8％)；其他并发症：胃肠排空延迟4例(6.4％)，胆漏3例(4.8％)，腹腔感染1例(1.6％)，术后出血1例(1.6％)，术后肺部感染2例(3.2％)。术后病理：胰头癌13例，胰腺肉瘤1例，胰腺局灶导管上皮非典型增生1例，肿块性胰腺炎5例，胆管癌17例，胆管腺瘤1例，十二指肠癌11例，十二指肠间质瘤1例，十二指肠壶腹部癌10例，胰管黏液性乳头状瘤(主胰管型)1例，胃癌侵犯胰头部1例。术后1周腹部彩超检查均未发现胰腺残端周围包裹性积液。62例术后随访3～12个月，均无腹泻、急慢性胰腺炎、胰管结石等胰腺外分泌功能受阻碍的临床表现。结论在3D LPD术中采用改进胰肠吻合法进行胰肠吻合，操作简单，安全可靠，临床可复制性强。
Abstract:
ObjectiveTo evaluate the application value of modified pancreaticojejunostomy in 3D laparoscopic pancreaticoduodenectomy (LPD).MethodsA retrospective analysis was performed on 62 patients who underwent 3D LPD with improved pancreaticojejunostomy in our department from January 2020 to July 2022. Interrupted through suture of pancreatic section was carried out. According to the “Hong’s one needle method”, the internal drainage tube of pancreatic duct was fixed. Single needle Prolene thread was used for twolayer continuous suture of pancreatic section and anterior and posterior wall of the jejunum.ResultsSpecimen resection and reconstruction of digestive tract were completed in 3D laparoscopy in all the 62 patients. The operation time was (247.1±30.2) min, the pancreaticojejunostomy time was (12.6±4.7) min, and the intraoperative blood loss was (189±66) ml. The postoperative hospitalization time was (12.3±4.7) d. There were 59 cases (95.2%) of Agrade biochemical leakage and 3 cases (48%) of Bgrade pancreatic leakage postoperatively. Other complications included delayed gastrointestinal emptying in 4 cases (64%), biliary leakage in 3 cases (4.8%), abdominal infection in 1 case (1.6%), postoperative bleeding in 1 case (1.6%), and postoperative pulmonary infection in 2 cases (3.2%). Postoperative pathology showed 13 cases of pancreatic head cancer, 1 case of pancreatic sarcoma, 1 case of focal ductal epithelial dysplasia of the pancreas, 5 cases of mass pancreatitis, 17 cases of cholangiocarcinoma, 1 case of cholangioadenoma, 11 cases of duodenal cancer, 1 case of duodenal stromal tumor, 10 cases of duodenal ampulla cancer, 1 case of pancreatic duct mucinous papilloma (main pancreatic duct type), and 1 case of gastric cancer invading the pancreatic head. One week after surgery, abdominal ultrasound examination did not reveal any encapsulated fluid accumulation around the pancreatic stump. All the 62 cases were followed up for 3-12 months after surgery, and there were no clinical manifestations of pancreatic exocrine function obstruction such as diarrhea, acute or chronic pancreatitis, or pancreatic duct stones.ConclusionThe application of modified pancreaticoduodenal anastomosis in 3D LPD is simple to operate, safe, and reliable, having a strong clinical replicability.

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备注/Memo

备注/Memo:
*通讯作者，Email:yuanjunjian@126.com
更新日期/Last Update: 2023-12-01