改良Kakita胰肠吻合技术在胰十二指肠切除术中的应用  

Application of modified Kakita pancreaticojejunostomy during pancreaticoduodenectomy

作　　者：陈志楠 赵安邦 刘志程 朱倩 秦弦 魏征 曾长江 周文富 杨潇[5] 王帅[6] 孙振纲[6] 金保涛[7] 胡凯[7] 刘志苏[1,3] 袁玉峰 杨智勇[1,2,3] Chen Zhinan;Zhao Anbang;Liu Zhicheng;Zhu Qian;Qin Xian;Wei Zheng;Zeng Changjiang;Zhou Wenfu;Yang Xiao;Wang Shuai;Sun Zhengang;Jin Baotao;Hu Kai;Liu Zhisu;Yuan Yufeng;Yang Zhiyong(Department of Hepatobiliary&Pancreatic Surgery,Zhongnan Hospital of Wuhan University,Hubei Wuhan 430071,China;Pancreatic Surgery Center,Zhongnan Hospital of Wuhan University,Hubei Wuhan 430071,China;Clinical Medical Research Center for Mini-invasive Procedure of Hepatobiliary&Pancreatic Diseases of Hubei Province,Hubei Wuhan 430071,China;Department of Hepatobiliary Surgery,Affiliated First Municipal People's Hospital,Yangtze University,Hubei Xiantao 433099,China;Department of Hepatobiliary Surgery,Central Municipal Hospital,Hubei Qianjiang 433199;Department of Hepatobiliary Surgery,Affiliated Municipal Hospital,Yangtze University,Hubei Jingzhou 434020,China;Department of General Surgery,Second Municipal People's Hospital,Hubei Jingzhou 434000,China)

机构地区：[1]武汉大学中南医院肝胆胰外科,湖北武汉430071 [2]武汉大学中南医院胰腺外科中心,湖北武汉430071 [3]湖北省肝胆胰疾病微创诊治临床医学研究中心,湖北武汉430071 [4]长江大学附属仙桃市第一人民医院肝胆外科,湖北仙桃433099 [5]潜江市中心医院肝胆外科,湖北潜江433199 [6]长江大学附属荆州医院肝胆外科,湖北荆州434020 [7]荆州市第二人民医院普外一科,湖北荆州434000

出　　处：《腹部外科》2024年第1期56-63,共8页Journal of Abdominal Surgery

基　　金：湖北省肝胆胰疾病微创诊治临床医学研究中心平台匹配经费(PTPP2021005)。

摘　　要：目的探讨改良Kakita胰肠吻合技术(pancreaticojejunostomy,PJ)在胰十二指肠切除术(pancreaticoduodenectomy,PD)中的应用效果。方法选取2018年5月至2022年6月期间于武汉大学中南医院等5家医院采用改良Kakita PJ进行PD的病人,其中将153例行开腹PJ的病人分为A组,将110例行微创PJ的病人分为B组。A组包括135例开腹胰十二指肠切除术,13例微创PD中转开腹以及5例微创PD小切口吻合病人;B组包括87例腹腔镜下胰十二指肠切除术以及23例机器人辅助胰十二指肠切除术病人。回顾性分析两组病人的围术期临床资料。结果263例PD均顺利完成。(1)A组:PJ时间中位数为9 min(7~15 min),术中出血量中位数为200 mL(50~1000 mL),18例(11.8%)术后并发症Clavien-Dindo分级≥3级,B、C级胰瘘14例(9.2%),胆漏8例(5.2%),B、C级腹腔内出血13例(8.5%),消化道出血1例(0.7%),腹腔内感染14例(9.2%),术后30 d内再次手术者8例(5.2%),术后90 d内死亡2例(1.3%),死亡病例均由胰瘘引起。(2)B组:PJ时间中位数为17 min(12~25 min),术中出血量中位数为60 mL(10~250 mL),7例(6.4%)术后并发症Clavien-Dindo分级≥3级,B、C级胰瘘5例(4.6%),胆漏5例(4.6%),B、C级腹腔内出血3例(2.7%),消化道出血1例(0.9%),腹腔内感染9例(8.2%),术后30 d内再次手术者3例(2.7%),术后90 d内死亡者1例(0.9%),死亡病例与胰瘘无关。结论改良Kakita PJ操作简便,易于开展,可在开腹以及微创PD中安全实施。Objective To explore the feasibility of modified Kakita pancreaticojejunostomy(PJ)during pancreaticoduodenectomy(PD).Methods Between May 2018 and June 2022,153 patients undergoing open PJ were selected as group A while 110 patients undergoing mini-invasive PJ as group B.In group A,the procedures included open pancreaticoduodenectomy(OPD,n=135),mini-invasive PD with a conversion into laparotomy(n=13)and mini-invasive PD with a small retrieval incision reconstruction(n=5).In group B,laparoscopic pancreaticoduodenectomy(LPD,n=87)and robotic pancreaticoduodenectomy(RPD,n=23).The perioperative clinical data of two groups were retrospectively reviewed.Results A total of 263 cases of PD were successfully performed.In group A,median time of PJ was 9(7-15)min and median volume of blood loss 200(50-1000)mL.There were postoperative complication(Clavien-Dindo≥3)(n=18,11.8%),grade B/C postoperative pancreatic fistula(POPF)(n=14,9.2%)and biliary fistula(n=8,5.2%).There were grade B/C intra-abdominal hemorrhage(n=13,8.5%)and gastrointestinal hemorrhage(n=1,0.7%).Fourteen patients(9.2%)were diagnosed as intra-abdominal infection.30-day reoperation occurred in 8 patients(5.2%)and 2 patients(1.3%)died because of grade C POPF within 90 days of surgery.In group B,median time of PJ was 17(12-25)min and median volume of blood loss 60(10-250)mL.Among postoperative complication(Clavien-Dindo≥3)(n=7,6.4%),there were grade B POPF(n=5,4.6%),biliary fistula(n=5,4.6%),grade B/C intra-abdominal hemorrhage(n=3,2.7%)and gastrointestinal hemorrhage(n=1,0.9%).Nine patients(8.2%)were diagnosed as intra-abdominal infection.30-day reoperation occurred(n=3,2.7%)and 1 patient(0.9%)died within 90 days of surgery.Conclusion With a short learning curve,modified Kakita PJ may be performed under OPD or mini-invasive PD.

关 键 词：胰十二指肠切除术 胰肠吻合技术 机器人 腹腔镜 术后胰瘘 

分 类 号：R657.5[医药卫生—外科学] R619[医药卫生—临床医学]