背景:术后胰瘘(POPFs)发生在20%至30%的腹腔镜远端胰管切除术后。本研究旨在评估使用三排吻合器进行腹腔镜远端胰腺切除术预防POPFs的临床疗效。
方法:在2016年4月至2023年5月之间,59例患者接受了完全腹腔镜远端胰腺切除术。女性(n=34,57.6%)多于男性(n=25,42.4%)。患者的中位年龄为68.9岁。将患者分为缓慢压缩组(n=19)和无压缩组(n=40),并检查胰漏。两组都进行了年龄方面的检查,性别,体重指数(BMI),胰腺解剖部位的胰腺厚度,胰腺质地,诊断,手术时间,失血,POPF的存在,排水沟拆除日期,和住院时间。此外,在多变量分析中检查了POPF的危险因素.
结果:在9例患者中发现了B级POPFs(15.3%)。使用单变量分析,手术时间,失血,术后胰液渗漏,排水去除日,无压迫组的住院时间短于缓慢压迫组.使用多变量分析,无压缩组缺乏POPFs的频率明显更高(比值比,5.69;95%CI,1.241-26.109;P=0.025)。无压迫胰腺清扫法是降低POPF发生率的简单方法。
结论:快速解剖胰腺而不压迫的方法比缓慢解剖胰腺的方法产生更好的结果。这种无压迫的快速解剖是一种简单而安全的方法,可最大限度地减少术后胰液渗漏,缩短了手术时间和住院时间,降低医疗费用。因此,这种方法可能是临床上成功的选择.
BACKGROUND: Postoperative pancreatic fistulas (POPFs) occur after 20% to 30% of laparoscopic distal pancreatectomies. This
study aimed to evaluate the clinical efficacy of laparoscopic distal pancreatectomy using triple-row staplers in preventing POPFs.
METHODS: Between April 2016 and May 2023, 59 patients underwent complete laparoscopic distal pancreatectomies. There were more females (n=34, 57.6%) than males (n=25, 42.4%). The median age of the patients was 68.9 years. The patients were divided into slow-compression (n=19) and no-compression (n=40) groups and examined for pancreatic leakage. Both groups were examined with respect to age, sex, body mass index (BMI), pancreatic thickness at the pancreatic dissection site, pancreatic texture, diagnosis, operative time, blood loss, presence of POPF, date of drain removal, and length of hospital stay. In addition, risk factors for POPF were examined in a multivariate analysis.
RESULTS: Grade B POPFs were found in 9 patients (15.3%). Using univariate analysis, the operative time, blood loss, postoperative pancreatic fluid leakage, day of drain removal, and hospital stay were shorter in the no-compression group than in the slow-compression group. Using multivariate analysis, the absence of POPFs was significantly more frequent in the no-compression group (odds ratio, 5.69; 95% CI, 1.241-26.109; P =0.025). The no-compression pancreatic dissection method was a simple method for reducing POPF incidence.
CONCLUSIONS: The method of quickly dissecting the pancreas without compression yielded better results than the method of slowly dissecting the pancreas with slow compression. This quick dissection without compression was a simple and safe method that minimized postoperative pancreatic fluid leakage, shortened the operative time and length of hospital stay, and reduced medical costs. Therefore, this method might be a clinically successful option.