Application of Imbedding Pancreaticojejunostomy in Pure Laparoscopic Pancreatico-duodenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 MAChun-yang , ZHUFeng , XIAOGuang-qin , ZHANGHang , GUOXing-jun , GAOHeng-yi , WANGHe-bin , RENYu-qi , WANGMin ,  QINRen-yi

Department of Biliary Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China;

Corresponding author：

QINRen-yi, Email: ryqin@tjh.tjmu.edu.cn

Keywords：

Laparoscopic pancreaticoduodenectomy; Imbedding pancreaticojejunostomy; Pancreatic duct jejunum mucosa to side anastomosis; Pancreatic fistula

DOI：

10.7507/1007-9424.20160104

Video：

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Objective To investigate the application of imbedding pancreaticojejunostomy in pure laparoscopic pancreaticoduodenectomy. Methods Eighty-five cases of laparoscopic pancreaticoduodenectomy in our hospital from May 2014 to December 2015 were analyzed retrospectively. According with inclusion criteria and exclusion criteria, 78 cases were investigated. They were divided into pancreatic duct-to-jejunum mucosa pancreaticojejunostomy group as controlled group (n=42) and imbedding pancreaticojejunostomy (technique of duct-to-mucosa PJ with transpancreatic interlocking mattress sutures) group as modified group (n=36). The rates of pancreatic fistula, abdominal infection/abscess, bile leakage, delayed gastric emptying, gastrointestinal/intraabdominal hemorrhage, pulmonary infection, and incision infection were investigated as well as hospital stays and pancreaticojejunostomy time in two groups were compared. Results The rate of pancreatic fistula especially B to C grade pancreatic fistula in the modified group was obviously lower compared with which in the controlled group (8.3% vs. 31.0%, P < 0.05), pancreaticojejunostomy time ofmodified group was significantly shortened [(35.6±12.4) min vs. (52.8±24.6) min, P < 0.05] and total operative time also shortened [(322.4±23.6) min vs. (384.2±30.2) min, P < 0.05). There were no significant difference of the rates of abdominal infection/abscess, bile leakage, delayed gastric emptying, gastrointestinal/intraabdominal hemorrhage, pulmonary infection, ?incision infection, and hospital stays (P > 0.05)]. Conciusions The type of pancreaticojejunostomy has a significant impact on the rate of pancreatic fistula after laparoscopic pancreaticoduodenectomy. Imbedding pancreaticojejunostomy can decrease the rate of pancreatic fistula after operation, and shorten the pancreaticojejunostomy time and total operative time.

Citation： MAChun-yang, ZHUFeng, XIAOGuang-qin, ZHANGHang, GUOXing-jun, GAOHeng-yi, WANGHe-bin, RENYu-qi, WANGMin, QINRen-yi. Application of Imbedding Pancreaticojejunostomy in Pure Laparoscopic Pancreatico-duodenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(4): 388-392. doi: 10.7507/1007-9424.20160104 Copy

1.	张亚武, 王哲元, 权柯.腹腔镜与开腹胰十二指肠切除术治疗胰头癌的疗效对比分析.中国普外基础与临床杂志, 2015, 22(9): 1078-1082.
2.	Kawai M, Yamaue H. Analysis of clinical trials evaluating complica tions after pancreaticoduodenectomy: a new era of pancreatic surgery. Surg Today, 2010, 40(11): 1011-1017.
3.	Ansorge C, Strömmer L, Andrén-Sandberg Å, et al. Structured intr aoperative assessment of pancreatic gland characteristics in predic ting complications after pancreaticoduodenectomy. Br J Surg, 2012, 99(8): 1076-1082.
4.	Daskalaki D, Butturini G, Molinari E, et al. A grading system can predict clinical and economic outcomes of pancreatic fistula after pancreaticoduodenectomy: results in 755 consecutive patients. Langenbecks Arch Surg, 2011, 396(1): 91-98.
5.	Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery, 2005, 138(1): 8-13.
6.	Butturini G, Daskalaki D, Molinari E, et al. Pancreatic fistula: defini tion and current problems. J hepatobiliary pancreat surg, 2008, 15(3): 247-251.
7.	刘志毅, 李亚刚, 宋燕, 等.腹部手术后胃瘫综合征的临床研究.中国老年学杂志, 2008, 28(4): 400-401.
8.	田夫, 向进见, 李明忠, 等.不同胰肠吻合方式的临床效果比较.世界华人消化杂志, 2009, 17(30): 3160-3163.
9.	Sidi A, Lobato EB, Cohen JA. The American Society of Anesthesio logists' Physical Status: category V revisited. J Clin Anesth, 2000, 12(4): 328-334.
10.	Gumbs AA, Grès P, Madureira FA, et al. Laparoscopic vs. open resection of noninvasive intraductal pancreatic mucinous neopl asms. J Gastrointest Surg, 2008, 12(4): 707-712.
11.	李学璐, 朱丹丹, 杨春明, 等.微创胰十二指肠切除术新进展.中国普通外科杂志, 2015, 24(3): 402-407.
12.	左世东, 廖恒祥.胰十二指肠切除捆绑式胰肠吻合术21例临床分析.中国普通外科杂志, 2014, 23 (3): 395-397.
13.	张健, 韩广森, 王道海, 等.空肠造瘘预防胰十二指肠切除术后胆/胰瘘:附16例报告.中国普通外科杂志, 2013, 22(9): 1226-1228.
14.	吴祥虎, 朱峰, 王敏, 等.腹腔镜胰十二指肠切除术的安全性和有效性研究.中华腔镜外科杂志:电子版. 2015, 8(1): 8-11.
15.	Croome KP, Farnell MB, Que FG, et al. Total laparoscopic pancrea ticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg, 2014, 260(4): 633-638.
16.	卫洪波, 魏波, 郑宗珩, 等.腹腔镜与开放胰十二指肠切除术疗效的对比观察.中华胃肠外科杂志, 2014, 17(5): 465-468.
17.	张华, 王明俊, 王昕, 等.腹腔镜胰十二指肠切除术45例体会.中国普外基础与临床杂志, 2014, 21(8): 940-945.
18.	骆霞岗, 汪宝林, 张建平, 等.腹腔镜技术在胰十二指肠切除术中的应用体会.中国现代医药杂志, 2012, 14(5): 58-60.
19.	朱胜昌, 黎堃. U型交锁缝合式胰肠吻合在胰十二指肠切除术中的应用.井冈山大学学报:自然科学版.2015, 36(6): 85-87.
20.	马炳奇, 张顺, 张斌, 等.胰十二指肠切除术后胰瘘发生的相关性因素分析.中国普通外科杂志, 2013, 22(3): 315-319.
21.	何友钊, 李建平, 顾元龙, 等.不同胰肠吻合方式的临床疗效分析.实用临床医药杂志, 2011, 15(5): 36-38.
22.	Shrikhande SV, Qureshi SS, Rajneesh N, et al. Pancreatic anasto moses after pancreaticoduodenectomy: do we need further studies? World J Surg, 2005, 29(12): 1642-1649.
23.	赵玉沛, 张太平.消化道重建基本原则与基本技术.中国实用外科杂志. 2014, 34(3): 197-204.
24.	张太平, 孙备, 董明.胰腺外科手术中胰腺断端吻合缝合技术及材料选择专家共识(2008).中国实用外科杂志, 2008, 28(10): 807-809.
25.	张秋学, 王铁功, 刘汝海, 等.不同胰肠吻合方式胰十二指肠切除术后胰瘘发生率比较.实用医学杂志, 2013, 29 (18): 3002-3004.
26.	周新红, 黄明, 胡明道, 等.胰十二指肠切除术后胰瘘发生的相关因素分析.中华消化外科杂志, 2012, 11(4): 335-338.
27.	贾会文, 刘驰, 张磊, 等. Blumgart吻合在胰十二指肠切除术后胰肠吻合中的应用.世界华人消化杂志, 2014, 22(33): 5170-5173.

1. 张亚武, 王哲元, 权柯.腹腔镜与开腹胰十二指肠切除术治疗胰头癌的疗效对比分析.中国普外基础与临床杂志, 2015, 22(9): 1078-1082.
2. Kawai M, Yamaue H. Analysis of clinical trials evaluating complica tions after pancreaticoduodenectomy: a new era of pancreatic surgery. Surg Today, 2010, 40(11): 1011-1017.
3. Ansorge C, Strömmer L, Andrén-Sandberg Å, et al. Structured intr aoperative assessment of pancreatic gland characteristics in predic ting complications after pancreaticoduodenectomy. Br J Surg, 2012, 99(8): 1076-1082.
4. Daskalaki D, Butturini G, Molinari E, et al. A grading system can predict clinical and economic outcomes of pancreatic fistula after pancreaticoduodenectomy: results in 755 consecutive patients. Langenbecks Arch Surg, 2011, 396(1): 91-98.
5. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery, 2005, 138(1): 8-13.
6. Butturini G, Daskalaki D, Molinari E, et al. Pancreatic fistula: defini tion and current problems. J hepatobiliary pancreat surg, 2008, 15(3): 247-251.
7. 刘志毅, 李亚刚, 宋燕, 等.腹部手术后胃瘫综合征的临床研究.中国老年学杂志, 2008, 28(4): 400-401.
8. 田夫, 向进见, 李明忠, 等.不同胰肠吻合方式的临床效果比较.世界华人消化杂志, 2009, 17(30): 3160-3163.
9. Sidi A, Lobato EB, Cohen JA. The American Society of Anesthesio logists' Physical Status: category V revisited. J Clin Anesth, 2000, 12(4): 328-334.
10. Gumbs AA, Grès P, Madureira FA, et al. Laparoscopic vs. open resection of noninvasive intraductal pancreatic mucinous neopl asms. J Gastrointest Surg, 2008, 12(4): 707-712.
11. 李学璐, 朱丹丹, 杨春明, 等.微创胰十二指肠切除术新进展.中国普通外科杂志, 2015, 24(3): 402-407.
12. 左世东, 廖恒祥.胰十二指肠切除捆绑式胰肠吻合术21例临床分析.中国普通外科杂志, 2014, 23 (3): 395-397.
13. 张健, 韩广森, 王道海, 等.空肠造瘘预防胰十二指肠切除术后胆/胰瘘:附16例报告.中国普通外科杂志, 2013, 22(9): 1226-1228.
14. 吴祥虎, 朱峰, 王敏, 等.腹腔镜胰十二指肠切除术的安全性和有效性研究.中华腔镜外科杂志:电子版. 2015, 8(1): 8-11.
15. Croome KP, Farnell MB, Que FG, et al. Total laparoscopic pancrea ticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg, 2014, 260(4): 633-638.
16. 卫洪波, 魏波, 郑宗珩, 等.腹腔镜与开放胰十二指肠切除术疗效的对比观察.中华胃肠外科杂志, 2014, 17(5): 465-468.
17. 张华, 王明俊, 王昕, 等.腹腔镜胰十二指肠切除术45例体会.中国普外基础与临床杂志, 2014, 21(8): 940-945.
18. 骆霞岗, 汪宝林, 张建平, 等.腹腔镜技术在胰十二指肠切除术中的应用体会.中国现代医药杂志, 2012, 14(5): 58-60.
19. 朱胜昌, 黎堃. U型交锁缝合式胰肠吻合在胰十二指肠切除术中的应用.井冈山大学学报:自然科学版.2015, 36(6): 85-87.
20. 马炳奇, 张顺, 张斌, 等.胰十二指肠切除术后胰瘘发生的相关性因素分析.中国普通外科杂志, 2013, 22(3): 315-319.
21. 何友钊, 李建平, 顾元龙, 等.不同胰肠吻合方式的临床疗效分析.实用临床医药杂志, 2011, 15(5): 36-38.
22. Shrikhande SV, Qureshi SS, Rajneesh N, et al. Pancreatic anasto moses after pancreaticoduodenectomy: do we need further studies? World J Surg, 2005, 29(12): 1642-1649.
23. 赵玉沛, 张太平.消化道重建基本原则与基本技术.中国实用外科杂志. 2014, 34(3): 197-204.
24. 张太平, 孙备, 董明.胰腺外科手术中胰腺断端吻合缝合技术及材料选择专家共识(2008).中国实用外科杂志, 2008, 28(10): 807-809.
25. 张秋学, 王铁功, 刘汝海, 等.不同胰肠吻合方式胰十二指肠切除术后胰瘘发生率比较.实用医学杂志, 2013, 29 (18): 3002-3004.
26. 周新红, 黄明, 胡明道, 等.胰十二指肠切除术后胰瘘发生的相关因素分析.中华消化外科杂志, 2012, 11(4): 335-338.
27. 贾会文, 刘驰, 张磊, 等. Blumgart吻合在胰十二指肠切除术后胰肠吻合中的应用.世界华人消化杂志, 2014, 22(33): 5170-5173.

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Application of Imbedding Pancreaticojejunostomy in Pure Laparoscopic Pancreatico-duodenectomy

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