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.

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 rein- forcing 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 amino- transferase, 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. [ABSTRACT FROM AUTHOR]