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.	張亞武, 王哲元, 權柯.腹腔鏡與開腹胰十二指腸切除術治療胰頭癌的療效對比分析.中國普外基礎與臨床雜志, 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, Str?mmer L, Andrén-Sandberg ?, 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.	劉志毅, 李亞剛, 宋燕, 等.腹部手術后胃癱綜合征的臨床研究.中國老年學雜志, 2008, 28(4): 400-401.
8.	田夫, 向進見, 李明忠, 等.不同胰腸吻合方式的臨床效果比較.世界華人消化雜志, 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.	李學璐, 朱丹丹, 楊春明, 等.微創胰十二指腸切除術新進展.中國普通外科雜志, 2015, 24(3): 402-407.
12.	左世東, 廖恒祥.胰十二指腸切除捆綁式胰腸吻合術21例臨床分析.中國普通外科雜志, 2014, 23 (3): 395-397.
13.	張健, 韓廣森, 王道海, 等.空腸造瘺預防胰十二指腸切除術后膽/胰瘺:附16例報告.中國普通外科雜志, 2013, 22(9): 1226-1228.
14.	吳祥虎, 朱峰, 王敏, 等.腹腔鏡胰十二指腸切除術的安全性和有效性研究.中華腔鏡外科雜志:電子版. 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.	衛洪波, 魏波, 鄭宗珩, 等.腹腔鏡與開放胰十二指腸切除術療效的對比觀察.中華胃腸外科雜志, 2014, 17(5): 465-468.
17.	張華, 王明俊, 王昕, 等.腹腔鏡胰十二指腸切除術45例體會.中國普外基礎與臨床雜志, 2014, 21(8): 940-945.
18.	駱霞崗, 汪寶林, 張建平, 等.腹腔鏡技術在胰十二指腸切除術中的應用體會.中國現代醫藥雜志, 2012, 14(5): 58-60.
19.	朱勝昌, 黎堃. U型交鎖縫合式胰腸吻合在胰十二指腸切除術中的應用.井岡山大學學報:自然科學版.2015, 36(6): 85-87.
20.	馬炳奇, 張順, 張斌, 等.胰十二指腸切除術后胰瘺發生的相關性因素分析.中國普通外科雜志, 2013, 22(3): 315-319.
21.	何友釗, 李建平, 顧元龍, 等.不同胰腸吻合方式的臨床療效分析.實用臨床醫藥雜志, 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.	趙玉沛, 張太平.消化道重建基本原則與基本技術.中國實用外科雜志. 2014, 34(3): 197-204.
24.	張太平, 孫備, 董明.胰腺外科手術中胰腺斷端吻合縫合技術及材料選擇專家共識(2008).中國實用外科雜志, 2008, 28(10): 807-809.
25.	張秋學, 王鐵功, 劉汝海, 等.不同胰腸吻合方式胰十二指腸切除術后胰瘺發生率比較.實用醫學雜志, 2013, 29 (18): 3002-3004.
26.	周新紅, 黃明, 胡明道, 等.胰十二指腸切除術后胰瘺發生的相關因素分析.中華消化外科雜志, 2012, 11(4): 335-338.
27.	賈會文, 劉馳, 張磊, 等. Blumgart吻合在胰十二指腸切除術后胰腸吻合中的應用.世界華人消化雜志, 2014, 22(33): 5170-5173.

1. 張亞武, 王哲元, 權柯.腹腔鏡與開腹胰十二指腸切除術治療胰頭癌的療效對比分析.中國普外基礎與臨床雜志, 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, Str?mmer L, Andrén-Sandberg ?, 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. 劉志毅, 李亞剛, 宋燕, 等.腹部手術后胃癱綜合征的臨床研究.中國老年學雜志, 2008, 28(4): 400-401.
8. 田夫, 向進見, 李明忠, 等.不同胰腸吻合方式的臨床效果比較.世界華人消化雜志, 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. 李學璐, 朱丹丹, 楊春明, 等.微創胰十二指腸切除術新進展.中國普通外科雜志, 2015, 24(3): 402-407.
12. 左世東, 廖恒祥.胰十二指腸切除捆綁式胰腸吻合術21例臨床分析.中國普通外科雜志, 2014, 23 (3): 395-397.
13. 張健, 韓廣森, 王道海, 等.空腸造瘺預防胰十二指腸切除術后膽/胰瘺:附16例報告.中國普通外科雜志, 2013, 22(9): 1226-1228.
14. 吳祥虎, 朱峰, 王敏, 等.腹腔鏡胰十二指腸切除術的安全性和有效性研究.中華腔鏡外科雜志:電子版. 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. 衛洪波, 魏波, 鄭宗珩, 等.腹腔鏡與開放胰十二指腸切除術療效的對比觀察.中華胃腸外科雜志, 2014, 17(5): 465-468.
17. 張華, 王明俊, 王昕, 等.腹腔鏡胰十二指腸切除術45例體會.中國普外基礎與臨床雜志, 2014, 21(8): 940-945.
18. 駱霞崗, 汪寶林, 張建平, 等.腹腔鏡技術在胰十二指腸切除術中的應用體會.中國現代醫藥雜志, 2012, 14(5): 58-60.
19. 朱勝昌, 黎堃. U型交鎖縫合式胰腸吻合在胰十二指腸切除術中的應用.井岡山大學學報:自然科學版.2015, 36(6): 85-87.
20. 馬炳奇, 張順, 張斌, 等.胰十二指腸切除術后胰瘺發生的相關性因素分析.中國普通外科雜志, 2013, 22(3): 315-319.
21. 何友釗, 李建平, 顧元龍, 等.不同胰腸吻合方式的臨床療效分析.實用臨床醫藥雜志, 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. 趙玉沛, 張太平.消化道重建基本原則與基本技術.中國實用外科雜志. 2014, 34(3): 197-204.
24. 張太平, 孫備, 董明.胰腺外科手術中胰腺斷端吻合縫合技術及材料選擇專家共識(2008).中國實用外科雜志, 2008, 28(10): 807-809.
25. 張秋學, 王鐵功, 劉汝海, 等.不同胰腸吻合方式胰十二指腸切除術后胰瘺發生率比較.實用醫學雜志, 2013, 29 (18): 3002-3004.
26. 周新紅, 黃明, 胡明道, 等.胰十二指腸切除術后胰瘺發生的相關因素分析.中華消化外科雜志, 2012, 11(4): 335-338.
27. 賈會文, 劉馳, 張磊, 等. Blumgart吻合在胰十二指腸切除術后胰腸吻合中的應用.世界華人消化雜志, 2014, 22(33): 5170-5173.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of Imbedding Pancreaticojejunostomy in Pure Laparoscopic Pancreatico-duodenectomy

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