肝圆镰状韧带一体化包裹加强技术在质软胰腺胰十二指肠切除术中的应用分析

摘要 目的：探讨质软胰腺胰十二指肠切除术（PD）中应用肝圆镰状韧带一体化包裹加强技术的临床价值。方法：回顾性分析哈尔滨医科大学附属肿瘤医院2016年1月至2021年12月实施开腹PD或保留幽门的胰十二指肠切除术（PPPD）质软胰腺病人的临床资料。根据是否应用肝圆镰状韧带一体化包裹加强技术分为无包裹加强组（2016.1-2018.12，246例）及包裹加强组（2019.1-2021.12，244例），比较两组病人基本临床特征、术中资料、术后资料、胰腺术后出血（PPH）病人治疗措施及转归。结果：术前基本临床资料中，两组病人在年龄、性别、术前高血压及糖尿病史、美国麻醉医师协会（ASA评分）、术前丙氨酸氨基转移酶、术前总胆红素、术前血清白蛋白、术前胆道引流、肿瘤位置及性质方面差异无统计学意义（P>0.05）。术中资料中，两组病人在手术时间、术中出血量、术中输血量、切除类型、PV 或SMV切除重建、主胰管直径方面差异无统计学意义（P>0.05）。术后资料中，两组病人在术后总体并发症、临床相关胰瘘（CR-POPF）及腹腔感染发生率、腹腔穿刺引流率、晚期腔外PPH及C级晚期腔外PPH发生率、PPH相关再手术率、总体再手术率、术后住院时间方面差异有统计学意义（P<0.05）；两组病人在术后胆瘘、延迟性胃排空障碍、早期PPH、晚期腔内PPH、A级及B级晚期腔外PPH、围手术期死亡率方面差异无统计学意义（P>0.05）。PPH病人治疗措施及转归资料中，两组PPH病人侵袭性治疗率差异有统计学意义（P<0.05）；两组PPH病人在不同侵袭性治疗措施及PPH病死率方面差异无统计学意义（P>0.05）。结论：肝圆镰状韧带一体化包裹加强技术能够降低质软胰腺PD术后总体并发症发生率、CR-POPF及晚期腔外PPH、C级晚期腔外PPH的发生率，同时降低病人腹腔感染发生率、腹腔穿刺置管引流率及再手术率，并缩短术后住院时间。

Analysis of the Application of Integrated Wrapping and Reinforcing Technique of Ligamentum Teres Hepatis and Falciform Ligament in Pancreaticoduodenectomy of Soft Pancreas

ABSTRACT Objective: To investigate the clinical application value of integrated wrapping and reinforcing technique of ligamentum teres hepatis and falciform ligament in pancreaticoduodenectomy (PD) of soft pancreas. Methods: Clinical data of patients with soft pancreas undergoing opern PD or pylorus-preserving pancreaticoduodenectomy (PPPD) were retrospectively analyzed in Harbin Medical University Cancer Hospital from January 2016 to December 2021. According to whether the integrated wrapping and reinforcing technique of ligamentum teres hepatis and falciform ligament was applied, the patients were divided into two groups: non-wrapping or reinforcing group (2016.1-2018.12, 246 cases), wrapping and reinforcing group (2019.1-2021.12, 244 cases). The basic preoperative characteristics, intraoperative data, postoperative data, treatment measures and outcomes of patients with post-pancreatectomy hemorrhage (PPH) were compared between the two groups. Results: In preoperative basic clinical data, there were no significant differences in age, gender, preoperative hypertension and diabetes history, American society of anesthesiologists (ASA) score, preoperative alanine aminotransferase, serum albumin and total bilirubin, preoperative biliary drainage, tumor location and tumor nature between the two groups (P>0.05). In intraoperative data, there were no significant differences in operative time, intraoperative blood loss, intraoperative blood transfusion, resection type, PV or SMV resection and reconstruction, and main pancreatic duct diameter between the two groups (P>0.05). In postoperative data, there were significant differences in the incidence of overall postoperative complications, clinically related postoperative pancreatic fistula (CR-POPF) and intra-abdominal infection, rate of percutaneous catheter drainage, incidence of late extraluminal post-pancreatectomy hemorrhage (PPH) and grade C late extraluminal PPH, and rates of PPH-related reoperation and total reoperation, and postoperative hospital stay between the two groups (P<0.05); There were no significant differences in postoperative biliary fistula, delayed gastric empty, early PPH, late intraluminal PPH, grade A and grade B late extraluminal PPH, and perioperative mortality between the two groups (P>0.05). In terms of treatment measures and outcomes of PPH patients, there was significant difference in the rate of the invasive treatment between the two groups (P<0.05); There were no significant differences in the different invasive treatment options and rate of PPH case-fatality between the two groups(P>0.05). Conclusion: The technique of integrated wrapping and reinforcing of ligamentum teres hepatis and falciform ligament can reduce the incidence of overall postoperative complications, CR-POPF, late extraluminal PPH and grade C late extraluminal PPH after PD in patients with soft pancreas, and it can also simultaneously reduce the incidence of intra-abdominal infection, the rates of percutaneous catheter drainage and reoperation, and shorten postoperative hospital stay.