Objective: To investigate the safety and feasibility of longitudinal transpancreatic U-sutures invaginated pancreatojejunostomy (Chen's pancreaticojejunostomy technique) in laparoscopic pancreaticoduodenectomy (LPD). Methods: Clinical data of 116 consecutive patients who underwent LPD using Chen's pancreaticojejunostomy technique in Hunan Provincial People's Hospital from May 2017 to December 2018 were retrospectively analyzed. Among these patients, 66 were males and 50 were females. The median age was 58 years old (32-84 yeas old). All 116 patients underwent pure laparoscopic whipple procedure with Child reconstruction method, using Chen's pancreaticojejunostomy technique. The intraoperative and postoperative data of patients were analyzed. Results: All 116 patients underwent LPD successfully. The mean operative time was (260.3±33.5) minutes (200-620 minutes). The mean time of pancreaticojejunostomy was (18.2±7.6) minutes (14-35 minutes). The mean time of hepaticojejunostomy was (14.6±6.3) minutes (10-25 minutes). The mean time of gastrojejunostomy was (12.0±5.5) minutes (8-20 minutes). The mean estimated blood loss was (106.0±87.6) ml (20-800 ml). Postoperative complications were: 11.2%(13/116) of cases had postoperative pancreatic fistula (POPF), including 10.3% (12/116) of biochemical fistula and 0.9%(1/116) of grade B POPF, no grade C POPF occurred; 10.3%(12/116) had gastrojejunal anastomotic bleeding; 3.4%(4/116) had hepaticojejunal anastomotic fistula; 3.4%(4/116) had delayed gastric emptying; 4.3% (5/116) had localized abdominal infection; 12.1%(14/116) had pulmonary infection; postoperative mortality were 0(0/116) and 1.7%(2/116) within 30 days and 90 days, respectively. One patient died of massive abdominal bleeding secondary to Gastroduodenal artery pseudoaneurysm rupture, the other patient died of extensive tumor recurrence and metastasis after surgery. Conclusions: Chen's pancreaticojejunostomy technique is safe and feasible for LPD.It is an option especially for surgeons who have not completed the learning curve of LPD.
目的： 探讨贯穿胰腺纵向"U"形缝合法空肠内翻套入式胰肠吻合技术在腹腔镜胰十二指肠切除术（LPD）中应用的安全性和实用性。 方法： 回顾性分析2017年5月至2018年12月湖南省人民医院肝胆外科实施LPD并采用贯穿胰腺纵向"U"形缝合法空肠内翻套入式胰肠吻合技术的116例患者的临床资料。男性66例，女性50例；中位年龄58岁（范围：32~84岁）。116例患者均在全腹腔镜下行不保留幽门的胰十二指肠切除术，采用Child法进行消化道重建，采用贯穿胰腺纵向"U"形缝合法空肠内翻套入式胰肠吻合技术进行胰肠吻合。记录患者术中和术后临床资料。 结果： 116例患者均顺利完成手术。手术时间为（260.3±33.5）min（范围：200~620 min），胰肠吻合时间为（18.2±7.6）min（范围：14~35 min），胆肠吻合时间为（14.6±6.3）min（范围：10~25 min），胃肠吻合时间为（12.0±5.5）min（范围：8~20 min），术中估计出血量为（106.0±87.6）ml（范围：20~800 ml）。术后并发症发生情况：胰腺生化漏12例（10.3%），B级胰瘘1例（0.9%），术后胃肠吻合口出血12例（10.3%），胆肠吻合口漏4例（3.4%），胃排空延迟4例（3.4%），腹腔局部感染5例（4.3%），肺部感染14例（12.1%）。术后30 d内无死亡病例，术后30~90 d死亡2例（1.7%），其中1例因胃十二指肠动脉残端假性动脉瘤破裂导致死亡，1例因低分化黏液性胰腺癌术后肿瘤复发、广泛转移导致死亡。 结论： 贯穿胰腺纵向"U"形缝合法空肠内翻套入式胰肠吻合法应用于LPD中安全有效，且操作简便，值得临床推广。.
Keywords: Laparoscopes; Pancreaticoduodenectomy; Pancreaticojejunostomy; Postoperative pancreatic fistula.