腹腔镜下保留十二指肠胰头切除术术前胆道支架植入临床效果研究OA

Objective To evaluate the clinical efficacy and safety of preoperative biliary stenting via endoscopic retrograde cholangiopancreatography(ERCP)in laparoscopic duodenum-preserving pancreatic head resection(LDPPHR).Methods The clinical data of 36 patients who underwent LDPPHR at the Third People's Hospital of Yunnan Province between January 2021 and January 2024 were retrospectively analyzed.According to whether preoperative biliary stenting was performed via ERCP,the patients were divided into the stent group(19 cases)and the non-stent group(17 cases).Perioperative indicators,such as operative time,intraoperative blood loss,and postoperative hospital stay,the incidences of postoperative complications including pancreatic fistula,biliary fistula,hemorrhage,delayed gastric emptying,and biliary stricture with bile duct stones,and the reoperation rate were compared and analyzed between the two groups.Results All 36 patients successfully underwent the surgery without conversion to open surgery.There were no statistically significant differences between the stent group and the non-stent group in operative time[220.00(190.00,240.00)min vs.237.50(200.00,272.25)min],intraoperative blood loss[100.00(100.00,200.00)mL vs.100.00(50.00,275.00)mL,P=0.806],and postoperative hospital stay[21.00(19.00,25.00)d vs.24.50(22.00,27.75)d](all P＞0.05).The differences in the incidences of postoperative pancreatic fistula,biliary fistula,hemorrhage,delayed gastric emptying,biliary stricture with stones,and the reoperation rate between the two groups were also not statistically significant(all P＞0.05).However,regarding specific complications,the absolute values of the incidence of biliary fistula(5.3％vs.17.6％)and the reoperation rate(0 vs.17.6％)in the stent group were lower than those in the non-stent group.In terms of complication management,multiple cases of biliary fistula in the non-stent group required later stenting for cure,and 1 case was forced to undergo surgical bilioenteric anastomosis due to the failure of endoscopic stone extraction,whereas all complications in the stent group were successfully cured by conservative or endoscopic interventions.Conclusion Preoperative prophylactic biliary stenting via ERCP is safe and feasible for LDPPHR,without increasing operative time and blood loss.Pre-stenting helps provide intuitive navigation during surgery to protect the common bile duct.Although it fails to show a statistically significant difference in reducing the incidence of complications limited by the sample size,it simplifies the subsequent management process of complications such as postoperative biliary fistula and biliary stricture to a certain extent,and can serve as an effective adjunct for the perioperative complication management of LDPPHR.