胰体尾切除术中胰腺残端闭合方式研究进展  

A review of pancreatic stump closure techniques following distal pancreatectomy

作　　者：钱涛 马涛 梁廷波[1] QIAN Tao;MA Tao;LIANG Ting-bo(Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital of Zhejiang University School of Medicine,Zhejiang Provincial Key Laboratory of Pancreatic Disease,Hangzhou 310003,China)

机构地区：[1]浙江大学医学院附属第一医院肝胆胰外科、浙江省胰腺病研究重点实验室,浙江杭州310003

出　　处：《中国实用外科杂志》2023年第7期828-832,共5页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金项目(No.82071748)。

摘　　要：术后胰瘘是胰体尾切除术后的常见并发症,提高术中胰腺残端封闭效果是预防和减少胰瘘的重要措施之一。手工缝合和切割闭合器闭合是目前应用最广泛的两种胰腺残端闭合方式,二者在预防术后胰瘘方面的效果相近;研究显示高分子材料配合手工缝合或切割闭合器闭合可加强胰腺残端的封闭效果,但仍需进一步的临床验证。当前证据表明纤维蛋白类生物胶和自体组织包裹胰腺残端不能防止胰瘘;胰腺残端与空肠或胃吻合不能降低胰瘘发生率,且延长手术时间,这些方法的临床应用已逐渐式微。如何进一步改善胰腺残端的封闭效果仍需进一步探索。Postoperative pancreatic fistula(POPF)is a common complication after distal pancreatectomy.Ensuring a safe closure of the pancreatic stump is crucial in reducing the incidence of POPF.Hand-sewn and stapler closure are the most commonly used methods for pancreatic stump closure.Their efficacy in preventing the occurrence of POPF is comparable according to available evidence.The usage of polymer materials may improve the sealing efficiency after hand-suture or stapling,although further studies are warranted to validate this finding.Sealing with biological gels and stump wrapping with autologous tissue are proven to be ineffective in preventing POPF.Anastomosis of the pancreatic stump to the jejunum or stomach doesn’t improve the occurrence of POPF but prolongs the operative duration.Further studies are needed to identify the most effective sealing method for preventing the occurrence of POPF after distal pancreatectomy.

关 键 词：胰体尾切除术 残端闭合 胰瘘 

分 类 号：R6[医药卫生—外科学]