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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2020, Vol. 14 ›› Issue (04) : 374 -377. doi: 10.3877/cma.j.issn.1674-3946.2020.04.016

所属专题： 机器人手术； 文献；

论著

"双U"三步法胰肠吻合术在机器人胰十二指肠切除术中的应用
朱洪银1, 霍天宇2, 崔王平1, 张昕宁1, 董烨1, 魏志刚2,†()   
  1. 1. 030001　太原，山西医科大学第一临床医学院
    2. 030001　太原，山西医科大学普外科
  • 收稿日期:2019-12-16 出版日期:2020-08-26
  • 通信作者: 魏志刚

Application of "double-U" three-step pancreaticojejunostomy in robotic pancreaticoduodenectomy

Hongyin Zhu1, Tianyu Huo2, Wangping Cui1, Xinning Zhang1, Ye Dong1, Zhigang Wei2,†()   

  1. 1. The First Medical College of Shanxi Medical University, Shanxi 030001, China
    2. Department of General Surgery, the First College of Shanxi Medical University, Shanxi 030001, China
  • Received:2019-12-16 Published:2020-08-26
  • Corresponding author: Zhigang Wei
  • About author:
    Corresponding author: Wei Zhigang, Email:
  • Supported by:
    Shanxi Key R&D Program Project(No. 201903D321144); Shanxi Province Graduate Education Innovation Project(2019SY248)
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引用本文：

朱洪银, 霍天宇, 崔王平, 张昕宁, 董烨, 魏志刚. "双U"三步法胰肠吻合术在机器人胰十二指肠切除术中的应用[J]. 中华普外科手术学杂志(电子版), 2020, 14(04): 374-377.

Hongyin Zhu, Tianyu Huo, Wangping Cui, Xinning Zhang, Ye Dong, Zhigang Wei. Application of "double-U" three-step pancreaticojejunostomy in robotic pancreaticoduodenectomy[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2020, 14(04): 374-377.

目的

探讨"双U"三步法胰肠吻合术(PJ)在机器人胰十二指肠切除术(RPD)中的可行性。

方法

回顾性分析2017年6月至2019年6期间行RPD的28例患者病例资料，对术中情况及术后并发症进行分析。

结果

28例患者均顺利完成手术，"双U"三步法吻合时间为17～35 min，平均23.5 min，术中出血量50～600 ml，平均178.3 ml。术后5例患者出现并发症，其中3例(8.6%)出现术后胰瘘(POPF)，均为B级，经抑制胰液分泌，延长腹腔引流时间及营养支持治疗后痊愈。2位患者出现胃排空延迟，经保守治疗后康复出院。平均术后住院时长13.9 d(3～63 d)，无住院期间死亡病例。

结论

"双U"三步法PJ操作简便，利于学习，吻合质量安全可靠，愈合快，应用范围广，对减少并发症及降低POPF有一定优势。

关键词: 胰十二指肠切除术, 机器人, 胰腺瘘, "双U"三步法, 胰肠吻合术
Objective

To explore the feasibility of "double-U" three-step pancreaticojejunostomy (PJ) in robot pancreaticoduodenectomy (RPD).

Methods

The clincal data of 28 patients who underwent RPD from June 2017 to June 2019 were analyzed retrospectively, and the intraoperative conditions and postoperative complications were analyzed.

Results

All of 28 patients received successful operation. The anastomosis time of "double-U" three-step method ranged from 17 to 35 min, with an average of 23.5 min. The intraoperative blood loss ranged from 50 to 600 ml, with an average of 178.3 ml. Postoperative complications occurred in 5 patients, of which 3 (8.6%) had postoperative pancreatic fistula(POPF) with grade B, which were cured after inhibition of pancreatic juice secretion, prolongation of abdominal drainage time and nutritional support treatment. Two patients developed delayed gastric emptying and were discharged after conservative treatment. The average postoperative hospital stay was 13.9 days (3~63 days), and there was no death during hospitalization.

Conclusion

The "double-U" three-step PJ method is easy to operate, convenient for learning, safe and reliable for ensuring anastomosis quality, with faster recovery and potential wider clinical application. It has certain advantages in reducing complications such as POPF.

Key words: Pancreaticoduodenectomy, Robotics, Pancreatic fistula, "Double-U" three-step method, Pancreaticojejunostomy
图1 "双U"三步法示意图
图2 A：第一步，在胰管两侧贯穿胰腺与空肠浆肌层进行两个垂直U形缝合。B：第一步完成后，空肠被插入胰腺后面。C：第二步，于12点及6点方向将胰管及其周围胰腺与空肠全层进行两个纵向U行缝合。D：第三步将胰管前壁及其前面的胰腺组织与空肠全层间断缝合。
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