Clinical Application Research Of "Double-U" Three-step Pancreaticojejunostomy

Objective: The efficacy of robotic pancreaticoduodenectomy(RPD)versus open pancreaticoduodenectomy(RPD)in the treatment of periampullary cancer was compared.A new method of pancreaticojejunostomy,the "double U" three-step method,is introduced,and its safety,feasibility and effectiveness in pancreaticoduodenectomy are discussed.Methods: A retrospective analysis of clinical data of 92 patients undergoing pancreaticoduodenectomy in the Department of General Surgery,First Hospital of Shanxi Medical University from June 2017 to December 2019 for pancreaticojejunostomy,the "double U" three-step method is used.According to the operation method,they were divided into RPD group(n = 49)and OPD group(n = 43).The surgical parameters and perioperative efficacy were compared and analyzed in the two groups.If the quantitative data conforms to the normal distribution,it is expressed as mean ± standard deviation().Means are compared using two independent sample t tests.If it does not conform to the normal distribution,the median and quartile M(Q1,Q3)Means non-parametric test(Mann-Whitney U method).Count data were compared using chi-square test or Fisher exact test.P <0.05 was considered statistically significant.Results: In the RPD group,the operation time was 330(278,392)minutes,of which the anastomosis time was 23.10(20.55,24.20)minutes,the intraoperative blood loss was 164.29(50,200)ml,and the blood transfusion rate was 18.4%(9/49).The operation time of OPD group was 241(200,400)min,pancreaticojejunostomy time was 9.10(8.10,9.50)min,intraoperative blood loss was 355.14(100,500)ml,and blood transfusion rate was 48.4%(21/43).The total operation time and abnormal anastomosis time in the RPD group were longer than those in the OPD group,but the intraoperative blood loss and transfusion rate were lower than those in the OPD group,and the differences were statistically significant(P <0.05).A total of 8 complications occurred in the postoperative RPD group.There were 5 cases of delayed gastric emptying and 3 cases of pancreatic fistula(both grade B).Among them,1 had pancreatic fistula with delayed gastric emptying,and 1 had pancreatic fistula with biliary fistula.Abdominal infection;OPD group had a total of 11 cases of postoperative complications,including 1 case of simple grade B pancreatic fistula,1 case of simple biliary fistula,5 cases of delayed gastric emptying alone,and delayed gastric emptying combined with biliary fistula and pancreatic fistula,respectively.There were 2 cases of grade C pancreatic fistula with abdominal infection.There was no statistical difference in the incidence of pancreatic fistula,biliary fistula,delayed gastric emptying,and abdominal infection in the two groups(P> 0.05).All grade B pancreatic fistulas the patient healed by inhibiting pancreatic fluid secretion,prolonging the abdominal drainage time and nutritional support treatment.In the RPD group,1 case of pancreatic fistula combined with bile fistula was diagnosed as bile-enteric anastomosis during surgery,and after symptomatic treatment was given again,the symptom was improved;2 cases of C-grade pancreatic fistula in the OPD group were diagnosed with PD early.Patients underwent surgery for pancreatic-enteric anastomosis,and were discharged with a tube after full drainage.The average length of postoperative hospital stay in the RPD and OPD groups was 11(9,14)days and 15(9.5,18)days,respectively,with significant differences(P = 0.002).There were no deaths during perioperative period in both groups.Conclusion:The "double U" three-step pancreaticojejunostomy is easy to operate,conducive to learning,the quality of anastomosis is safe and reliable,the incidence of pancreatic fistula is low,and the application is wide.It is safe and feasible in open surgery and minimally invasive surgery,and has high clinical application value.By comparison with the efficacy of the OPD group,RPD has minimally invasive advantages such as less intraoperative damage and quicker postoperative recovery,without increasing the incidence of postoperative complications,and has great potential for development.