腹腔镜胰十二指肠切除术中胰颈直线切割闭合后主胰管分型及处理策略  

Classification of main pancreatic duct and treatment strategy after linear stapler closure of pancreatic neck in laparoscopic pancreaticoduodenectomy

作　　者：王向涛 孔健[2] 高君[2] 孔新亮 柯山[2] 王强 王劭宏[2] 宁纯民 国士刚 董姝英 宓立强 李文晓[6] 韩双喜[7] 李敬龙 孙文兵[2] Wang Xiangtao;Kong Jian;Gao Jun;Kong Xinliang;Ke Shan;Wang Qiang;Wang Shaohong;Ning Chunmin;Guo Shigang;Dong Shuying;Mi Liqiang;Li Wenxiao;Han Shuangxi;Li Jinglong;Sun Wenbing(Department of Hepatobiliary-Pancreatic-Splenic Surgery,Binzhou Second People's Hospital,Binzhou 256800,China;Department of Hepatobiliary-Pancreatic-Splenic Surgery,Shijingshan Campus,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100043,China;Rizhao Hepatobiliary-Pancreatic-Splenic Surgery Research Institute,Rizhao 276801,China;Department of Hepatobiliary Surgery,Chaoyang Central Hospital,Chaoyang 122099,China;Department of Hepatobiliary Surgery,Shandong Juxian People's Hospital,Rizhao 276599,China;Department of Hepatobiliary Surgery,Weihai Municipal Hospital,Weihai 264299,China;Department of Hepatobiliary Surgery,Binzhou Central Hospital,Binzhou 251799,China;Department of Hepatobiliary Surgery,Affiliated Hospital of Chifeng University,Chifeng 024099,China)

机构地区：[1]滨州市第二人民医院肝胆胰脾外科,滨州256800 [2]首都医科大学附属北京朝阳医院石景山院区肝胆胰脾外科,北京100043 [3]日照市肝胆胰脾外科研究所,日照276801 [4]朝阳市中心医院肝胆外科,朝阳122099 [5]山东莒县人民医院肝胆外科,日照276599 [6]威海市立医院肝胆外科,威海264299 [7]滨州市中心医院肝胆外科,滨州251799 [8]赤峰学院附属医院肝胆外科,赤峰024099

出　　处：《国际外科学杂志》2023年第6期390-393,共4页International Journal of Surgery

摘　　要：目的探讨腹腔镜胰十二指肠切除术(LPD)中胰颈直线切割闭合后主胰管分型及处理策略。方法回顾性分析2022年2~12月于滨州市第二人民医院、首都医科大学附属北京朝阳医院石景山院区、日照市肝胆胰脾外科研究所、朝阳市中心医院、山东莒县人民医院、威海市立医院、滨州市中心医院和赤峰学院附属医院应用胰颈直线切割闭合技术的51例LPD患者的临床资料。按照胰腺断端主胰管的可视性、位置及直径,将主胰管分为Ⅰ型、Ⅱ型、Ⅲa型和Ⅲb型。观察每个主胰管分型的病例数及相应的处理策略。结果51例患者实施LPD均获得成功。51例LPD中,男性占56.9%(29/51),女性占43.1%(22/51),年龄为31~88岁。胰腺断端主胰管的类型:Ⅰ型7例(13.7%),Ⅱ型39例(76.5%),Ⅲa型2例(3.9%),Ⅲb型3例(5.9%)。根据不同的主胰管分型采取相应的处理策略,均成功找到主胰管并插入支撑引流管。结论胰颈直线切割闭合后,根据主胰管分型采取相应的处理策略,有助于提高找到主胰管并置入支撑引流管的成功率。Objective To investigate the classification of main pancreatic duct and treatment strategy after linear stapler closure of pancreatic neck in laparoscopic pancreaticoduodenectomy(LPD).Methods The records of 51 consecutive patients with LPD who were treated by linear staple closure technique of pancreatic neck from February to December 2022 from Binzhou Second People's Hospital,Shijingshan Campus,Beijing Chaoyang Hospital,Capital Medical University,Rizhao Hepatobiliary-Pancreatic-Splenic Surgery Research Institute,Chaoyang Central Hospital,Shandong Juxian People's Hospital,Weihai Municipal Hospital,Binzhou Central Hospital,and Affiliated Hospital of Chifeng University were retrospectively reviewed.According to the visibility,position and diameter of the main pancreatic duct at the stump of the pancreas,the type of main pancreatic duct was divided into type Ⅰ,type Ⅱ,type Ⅲa and type Ⅲb.The number of cases in each main pancreatic duct classification and the corresponding treatment strategies were examined.Results A total of 51 cases of LPD were successfully completed.Of these patients,the males comprised 56.9%(29/51),and females comprised 43.1%(22/51),with age ranging from 31 to 88 years old.The type of the main pancreatic duct at the stump of the pancreas included 7 cases(13.7%)of type Ⅰ,39 cases(76.5%)of type Ⅱ,2 cases(3.9%)of type Ⅲa,and 3 cases(5.9%)of type Ⅲb.Corresponding treatment strategies were adopted according to different main pancreatic duct types,the main pancreatic duct was successfully found,and a support drainage tube was inserted.Conclusion After linear stapler closure of pancreatic neck,corresponding treatment strategies should be adopted according to the classification of the main pancreatic duct,which would help to improve the success rate of finding the main pancreatic duct and placing a support drainage tube.

关 键 词：胰十二指肠切除术 主胰管 胰肠吻合术 支撑引流管 胰颈直线切割闭合 

分 类 号：R657.5[医药卫生—外科学]