分离式胰肠引吻术在高危胰瘘患者达芬奇机器人胰十二指肠切除术中的应用OA

Objective To explore the safety and feasibility of separated pancreaticojejunal anastomosis in robotic pancreaticoduodenectomy by da Vinci S system for high-risk pancreatic fistula patients.Methods A retrospective analysis was conducted on the clinical data of 21 high-risk pancreatic fistula patients who underwent robotic pancreaticoduodenectomy using the separated pancreaticojejunostomy in the Chinese PLA Rocket Force Characteristic Medical Center from January 2012 to December 2024.The surgical procedure involved sealing the pancreatic stump,suturing the pancreatic duct pouch and fixing the drainage tube.The drainage tube of the pancreatic duct was placed inside the jejunal loop,and the jejunal loop was sutured and drawn together with the pancreatic stump.Results All 21 patients had a pancreatic duct diameter≤3 mm and a pancreatic fistula risk score(FRS)≥7,with an average pancreatojejunostomy time was(18.0±5.3)minutes.Eight cases(38.1%)showed no pancreatic fistula,11 cases(52.4%)experienced biochemical pancreatic leakage,which healed spontaneously after 7 to 15 days by conservative treatment,2 cases(9.5%)of grade B pancreatic fistula were treated with continuous infusion of somatostatin via a micro-infusion pump and sustained double-lumen tube lavage drainage,achieving healing at 25 days and 30 days postoperatively,respectively.No reoperations or perioperative mortality occurred.Conclusion Separated pancreaticojejunostomy is safe and feasible in the robot pancreaticoduodenectomy.It simplify the operation of pancreaticojejunostomy,and reduce the incidence of leakage of intestinal from pancreaticojejunal.It can reduced the incidence of postoperative grade B and grade C pancreatic fistulas in patients with a high risk of pancreatic fistula by reducing the occurrence of intestinal fluid leakage.Thereby it lowered the postoperative reoperation rate and mortality rate.