完全腹腔镜胰十二指肠切除术中“洪氏一针法”联合“陈氏缝合技术”的临床应用体会

  目的  探讨完全腹腔镜胰十二指肠切除术中联合“洪氏一针法”及“陈氏缝合技术”进行胰肠吻合的操作要点及临床效果。  方法  回顾性分析蚌埠医学院第一附属医院2018年4月至2020年11月在腹腔镜胰十二指肠切除术中联合应用“洪氏一针法”及“陈氏缝合技术”进行胰肠吻合的65例患者临床资料。  结果  患者均在腹腔镜下完成标本切除及消化道重建。术中观察:手术时间（291.08±58.77）min，标本切除时间（159.54±31.50）min，胰肠吻合时间（43.38±6.32）min，术中出血量（151.54±102.69）mL，输血患者比例为6.15%（4/65）。并发症:A级胰瘘12例，B级胰瘘5例，胆瘘4例，胃排空障碍4例，肺部感染2例，腹腔积液2例，消化道出血1例。术后平均下床活动时间（2.26±0.59）天，平均排气时间（3.91±0.76）天，平均进食时间（4.57±0.75）天，平均住院时间（14.28±5.42）天。无死亡病例。再入院患者1例，原因为消化道出血，DSA血管造影提示胃十二指肠动脉动脉瘤出血，栓塞后治愈。  结论  在完全腹腔镜胰十二指肠切除术中联合应用“洪氏一针法”及“陈氏缝合技术”进行胰肠吻合，胰肠吻合时间较短，操作较简单，术后胰瘘发生率较低，吻合安全确切，值得临床推广应用。 

Clinical application experience of "Hong's one stitch" combined with "Chen's suture technique" in complete laparoscopic pancreaticoduodenectomy

  Objective  To explore the main operation points and clinical effects of the combined application of “Hong’s one stitch" method and “Chen’s suture technique” in complete laparoscopic pancreaticoduodenectomy (LPD).   Methods  The clinical data of 65 patients who underwent total LPD with the combined application of “Hong’s one stitch" method and “Chen’s suture technique” in The First Affiliated Hospital of Bengbu Medical College from April 2018 to November 2020 were retrospectively analyzed.  Results  All of the patients underwent complete specimen resection and gastrointestinal reconstruction under laparoscopy. Intraoperative observation indices were as follows: average operation time, (291.08±58.77) min; average specimen resection time, (159.54±31.50) min; average pancreaticojejunostomy time, (43.38±6.32) min; average intraoperative blood loss, (151.54±102.69) mL; and proportion of patients undergoing blood transfusion, 6.15% (4/65). Postoperative situation: complications: there were 12 cases of grade A pancreatic fistula, 5 cases of grade B pancreatic fistula, 4 cases of biliary, 4 cases of emptying disorder, 2 cases of lung infection, 2 cases of abdominal effusion, and 1 case of gastrointestinal bleeding. The average time the patients took to progress from being bedridden after the operation was (2.26±0.59) d, the mean postoperative exhaust time was (3.91+0.76) d, the average postoperative eating time was (4.57±0.75) d, the average postoperative hospital stay was (14.28±5.42) d. There was no case of mortality in the perioperative period. One patient was re-admitted after discharge due to gastrointestinal bleeding. DSA angiography revealed gastroduodenal artery aneurysm bleeding, which was cured after embolization.   Conclusions  In summary, the combination of “Hong’s one stitch" method and “Chen’s suture technique” in complete LPD decreases pancreaticojejunostomy time, increases the safety of the operation method, decreases the rate of postoperative pancreatic fistulas, allows for safer and more accurate anastomosis, and is worthy of clinical application.