Application Of Different Pancreaticojejunostomy In Laparoscopic Pancreaticoduodenectomy

Objective:To investigate the application of Hong's duct to mucosa pancreaticojejunostomy with a single stitch(HSDMP)?continuous lamellar pancreaticojejunostomy(CLP)and Chen's Suture Technique in Laparoscopic Pancreaticoduodenectomy.Methods:The clinical data of 135 patients who underwent LPD in our hospital from September 2017 to March 2019 were analyzed retrospectively,including Hong's duct to mucosa pancreaticojejunostomy with a single stitch(group A,n=28),continuous lamellar pancreaticoenterostomy(group B,n=65)and Chen's Suture Technique(group C,n=42).The general conditions such as sex,age,BMI,complicated with underlying diseases,ASA grade,intraoperative pancreaticoenterostomy time,pancreatic texture and diameter of main pancreatic duct were compared.The incidence of postoperative complications such as pancreatic fistula,biliary fistula and disturbance of gastric emptying and postoperative hospital stay.The above indexes were compared and analyzed in patients with pancreatic duct diameter less than 3mm in each group(group A,n=9,group B,n=16,group C,n=22).SPSS 22.0 was used for statistical analysis.The measurement data that satisfy the normal distribution are expressed as " x±s",and the measurement data that do not meet the normal distribution are represented by the median(quartile spacing),that is,M(Q).The measurement data that meet the normal distribution and uniform variance are compared and analyzed by ANOVA test,and the rest of the measurement data are analyzed by rank sum test,and the comparison of counting data between groups was analyzed by ?2 test or Fisher exact probability.P<0.05 indicated that the difference was statistically significant.Results:There was no significant difference in sex,age,BMI,underlying diseases,biliary drainage,ASA grade and laboratory examination among the three groups(P>0.05).The time needed to complete the anastomosis in group B(21.5±2.1min)was less than that in group A(27.5±2.4min)and group C(27.7±3.0min)(P<0.05).There was no significant difference in the diameter of main pancreatic duct,the texture of pancreas and the amount of intraoperative blood loss among the three groups(P>0.05).The incidence of postoperative pancreatic fistula in group A,group B and group C was 17.9%,16.9%and 16.7%,respectively,and there was no significant difference among the three groups(P>0.05).There was no significant difference in the incidence of postoperative complications such as gastric emptying,biliary fistula,abdominal infection and postoperative bleeding among the three groups(P>0.05).The hospitalization days of the three groups were 13.0±0.8 days in group A,12.6±1.0 days in group B and 12.6±1.2 days in group C,respectively,with no significant difference(P>0.05).In patients with pancreatic duct diameter less than 3mm,the incidence of postoperative pancreatic fistula in Chen's Suture Technique group was only 4.5%,which was significantly lower than that Hong's duct to mucosa pancreaticojejunostomy group(44.4%)and CLP group(37.5%).Conclusion:Hong's duct to mucosa pancreaticojejunostomy with a single stitch(HSDMP)?continuous lamellar pancreaticojejunostomy(CLP)and Chen's Suture Technique are all safe and feasible methods of laparoscopic pancreaticoenterostomy,continuous lamellar pancreaticoenterostomy is more convenient,and Chen's Suture Technique may be more beneficial to patients with slender pancreatic duct.