摘要
历经20年的临床实践,腹腔镜胰十二指肠切除术在我国发展迅速,胰肠吻合方式也不断有所创新及改良,不仅在理念层面深化了对吻合的认知,也推动了开放胰肠吻合术式的更新与进步。腹腔镜胰肠吻合多是在传统套入与胰管-黏膜吻合的基础上,结合腹腔镜手术操作的特点,围绕胰腺残端处理与胰管空肠重建进行的改良,尚无任何一种方式能适用于所有病人或完全避免胰瘘的发生。腹腔镜手术具有和开放手术完全不同的视角和操作方式,术者应结合本单位的设备条件、技术特点及熟练程度,根据病人的具体情况选择适宜的胰肠吻合方式。高质量的胰肠吻合应建立在安全、简便、可重复性好的基础上,并显著减少术后胰瘘的发生。
During 20 years of clinical practice,laparoscopic pancreaticoduodenectomy has developed rapidly in China.The modalities of pancreaticoduodenal anastomosis have been innovated and improved,which further deepened the understanding of anastomotic healing,meanwhile promoting the progress of open pancreaticointestinal anastomosis.Focusing on the management of pancreatic stump and the featuresoflaparoscopicsurgery,laparoscopic pancreaticojejunostomy was mostly improved and modified on basis of traditional invagination and duct-to-mucosa anastomosis.However,currently,there is still not a widelyaccepted method that can be applied to all patients,or completely avoid the occurrence of pancreatic fistula.Compared with laparotomy,laparoscopic surgery provides a detailed view and enables meticulous manipulation,so the surgeons should choose the individualized laparoscopic pancreaticojejunostomy by comprehensively considering the specific situation of the patient,the equipment conditions,and technical characteristics and proficiency of the operator.Highquality pancreaticojejunostomy should be based on safety,simplicity,and good reproducibility,with a reduction of the incidence of postoperative pancreatic fistula.
作者
田孝东
杨尹默
TIAN Xiao-dong;YANG Yin-mo(Department of General Surgery,Peking University First Hospital,Beijing 100034,China)
出处
《中国实用外科杂志》
CAS
CSCD
北大核心
2022年第5期509-513,共5页
Chinese Journal of Practical Surgery
基金
国家自然科学基金面上项目(No.81672353,No.81871954)。
关键词
胰十二指肠切除术
腹腔镜
胰肠吻合
胰瘘
pancreaticoduodenectomy
laparoscopy
pancreaticointestinal anastomosis
pancreatic fistula
