Abstract：
BACKGROUND: A stapler is usually used for transection and closure of the pancreas in distal pancreatectomy (DP) or central pancreatectomy (CP). When the pancreas is transected to the right of the portal vein, it is difficult to use a stapler and clinically relevant postoperative pancreatic fistula (CR-POPF) frequently occurs. We report on the efficacy of pancreaticojejunostomy (PJ) of the pancreatic stump for patients in whom stapler use is difficult.
METHODS: Patients who underwent DP or CP were enrolled in this study. The pancreas was usually transected by a stapler, and ultrasonic coagulating shears (UCS) were used depending on the tumor situation. When using UCS, hand-sewn closure or PJ was performed for the pancreatic stump. The relationship between clinicopathological factors and the methods of pancreatic transection and closure were investigated.
RESULTS: In total, 164 patients underwent DP or CP, and the pancreas was transected with a stapler in 150 patients and UCS in 14 patients. The rate of CR-POPF was higher and the postoperative hospital stay was longer in the UCS group than in the stapler group. PJ of the pancreatic stump, which was performed for 7 patients, did not worsen intraoperative factors. CR-POPF was not seen in these 7 patients, which was significantly less than that with hand-sewn closure.
CONCLUSIONS: PJ of the pancreatic stump during DP or CP reduces CR-POPF compared with hand-sewn closure and may be useful especially when the pancreas is transected to the right of the portal vein.
METHODS: Patients who underwent DP or CP were enrolled in this study. The pancreas was usually transected by a stapler, and ultrasonic coagulating shears (UCS) were used depending on the tumor situation. When using UCS, hand-sewn closure or PJ was performed for the pancreatic stump. The relationship between clinicopathological factors and the methods of pancreatic transection and closure were investigated.
RESULTS: In total, 164 patients underwent DP or CP, and the pancreas was transected with a stapler in 150 patients and UCS in 14 patients. The rate of CR-POPF was higher and the postoperative hospital stay was longer in the UCS group than in the stapler group. PJ of the pancreatic stump, which was performed for 7 patients, did not worsen intraoperative factors. CR-POPF was not seen in these 7 patients, which was significantly less than that with hand-sewn closure.
CONCLUSIONS: PJ of the pancreatic stump during DP or CP reduces CR-POPF compared with hand-sewn closure and may be useful especially when the pancreas is transected to the right of the portal vein.
摘要：
背景：在远端胰腺切除术（DP）或中央胰腺切除术（CP）中，吻合器通常用于横切和闭合胰腺。当胰腺被横切到门静脉的右边时，使用吻合器很困难，并且临床相关的术后胰瘘（CR-POPF）经常发生。我们报告了胰腺残端胰肠吻合术（PJ）对难以使用吻合器的患者的疗效。
方法：本研究纳入接受DP或CP的患者。胰腺通常用订书机横切,根据肿瘤情况使用超声凝固剪（UCS）。使用UCS时，对胰腺残端进行手工缝合闭合或PJ。研究了临床病理因素与胰腺横切和闭合方法之间的关系。
结果：总计，164例患者接受DP或CP，150例患者用吻合器横切胰腺，14例患者用UCS横切胰腺。UCS组的CR-POPF率高于吻合器组，术后住院时间更长。胰腺残端的PJ，对7名患者进行了手术，没有恶化术中因素。在这7例患者中未见到CR-POPF,这比手工缝制的要小得多。
结论：与手工缝合闭合相比，DP或CP期间胰腺残端的PJ降低了CR-POPF，尤其是当胰腺横切门静脉右侧时，可能是有用的。
方法：本研究纳入接受DP或CP的患者。胰腺通常用订书机横切,根据肿瘤情况使用超声凝固剪（UCS）。使用UCS时，对胰腺残端进行手工缝合闭合或PJ。研究了临床病理因素与胰腺横切和闭合方法之间的关系。
结果：总计，164例患者接受DP或CP，150例患者用吻合器横切胰腺，14例患者用UCS横切胰腺。UCS组的CR-POPF率高于吻合器组，术后住院时间更长。胰腺残端的PJ，对7名患者进行了手术，没有恶化术中因素。在这7例患者中未见到CR-POPF,这比手工缝制的要小得多。
结论：与手工缝合闭合相比，DP或CP期间胰腺残端的PJ降低了CR-POPF，尤其是当胰腺横切门静脉右侧时，可能是有用的。
