Evaluation of a new invagination technique of pancreatojejunostomy, the most delicate anastomoses: technical details and results of a personal series

The treatment of pancreatic stump is a critical step of pancreaticoduodenectomy (PD) because leaks from this anastomosis incur major morbidity and mortality. We describe technical details of a personal invagination pancreatojejunostomy (piPJ) and report on its safety. From October 2008 to October 2016, 401 pancreatic resections were performed, of which 187 were PD. A new invagination pancreaticojejunostomy (PJ) was introduced in November 2010 and used in 84 consecutive patients. Data were retrieved from a prospectively collected Institutional database, and used for present retrospective evaluation of the piPJ. Data were retrieved from a prospectively collected Institutional database, and used for present retrospective evaluation of the piPJ. ISGPFc POPF occurred in 14/84 (17%): grade A in 9/84 (11%), grade B in 4/84 (5%) and grade C in 1/84 (1.2%). On the ISGPSc, POPF rate averaged 6%: grade B in 4/84 (5%) and grade C in 1/84 (1.2%). POPF rate associated with high FRS was 20.0%/7% (ISGPFc/ISGPSc). With low and intermediate FRS, POPFs were 6%/0% (ISGPFc/ISGPSc) and 21%/8% (ISGPFc/ISGPSc) respectively. Re-operation rate was 3.6% (3/84). In-hospital mortality rate was 2.4% (2/84) and specific mortality rate for POPF was 1.2% (1/84).胰残端处理是胰十二指肠切除术（pancreaticoduodenectomy, PD）的关键步骤，因该吻合口漏可引发严重并发症与死亡风险。本文详述了个人套入式胰肠吻合术（personal invagination pancreatojejunostomy, piPJ）的技术细节，并报告了其临床安全性。2008年10月至2016年10月期间，本中心共完成401例胰腺切除术，其中187例为胰十二指肠切除术。2010年11月起引入新型套入式胰肠吻合术（pancreaticojejunostomy, PJ），并连续应用于84例患者。数据来自前瞻性收集的机构数据库，用于本次针对piPJ的回顾性评估。数据来自前瞻性收集的机构数据库，用于本次针对piPJ的回顾性评估。按国际胰腺外科研究小组分类（ISGPFc），术后胰瘘（postoperative pancreatic fistula, POPF）发生率为14/84（17%）：其中A级9/84（11%）、B级4/84（5%）、C级1/84（1.2%）。按国际胰腺外科研究小组分类（ISGPSc），术后胰瘘发生率平均为6%：其中B级4/84（5%）、C级1/84（1.2%）。高胰瘘风险评分（FRS）患者的术后胰瘘发生率为20.0%/7%（ISGPFc/ISGPSc）。低风险与中风险FRS患者的术后胰瘘发生率分别为6%/0%（ISGPFc/ISGPSc）与21%/8%（ISGPFc/ISGPSc）。再手术率为3.6%（3/84）。院内死亡率为2.4%（2/84），因术后胰瘘导致的特异性死亡率为1.2%（1/84）。