| Objective:Summarize and describe the specific surgical steps,technical difficulties,and key points of the novel intraluminal pancreaticojejunostomy technique;Analyze and evaluate the safety,feasibility,and clinical efficacy of this technique;Analyze the relevant risk factors for postoperative pancreatic fistula after pancreaticoduodenectomy.Methods:This study adopted a single-center prospective cohort design and enrolled a total of200 patients who underwent open pancreatoduodenectomy(OPD)surgery in the Department of Hepatobiliary Surgery at our hospital from January 2019 to December 2022.The clinical data of the patients were collected and divided into two groups based on the pancreaticojejunostomy method used: the novel invagination pancreaticojejunostomy group(NIP group,n=65)and the duct-to-mucosa pancreatojejunostomy group(DTMP group,n=135).The preoperative data of the two groups were collected,including patient name,hospital number,age,gender,BMI index,and past medical history,such as hypertension,diabetes,smoking,and drinking,family history,surgical history,preoperative jaundice history,and preoperative laboratory indicators(including blood routine,liver function,coagulation,and tumor markers,etc.).Intraoperative indicators included surgical method,surgical time,intraoperative blood loss,ASA classification,etc.Postoperative indicators included pathological results,lymph node metastasis,invasion of surrounding tissues,Clavien-Dindo classification,postoperative gastrointestinal decompression,postoperative complications(such as pancreatic fistula,bile fistula,bleeding),delayed gastric emptying,abdominal infection,pulmonary infection,length of hospital stay,hospitalization costs,and reoperation rate within one month.The main outcome measure of this study is the incidence of postoperative pancreatic fistula,while secondary outcome measures include delayed gastric emptying,postoperative bleeding,and the incidence of complications such as abdominal and pulmonary infections.By comparing the incidence of postoperative pancreatic fistula and related complications,the safety,feasibility,and clinical effectiveness of the novel invagination pancreaticojejunostomy technique in OPD surgery are evaluated.Results:1.There were no significant differences in age,sex,BMI,jaundice duration,ASA score,and preoperative laboratory tests between the two groups(P>0.05).Additionally,there were no significant differences between the two groups in terms of preoperative comorbidities such as hypertension,diabetes,smoking and drinking history,family history,surgical history,and pathological results(P>0.05).2.The main outcome of this study was the incidence of postoperative pancreatic fistula,and the secondary outcomes included delayed gastric emptying,postoperative bleeding,abdominal infection,and pulmonary infection.Compared with the DTMP group,the NIP group had a significantly lower incidence of postoperative pancreatic fistula(13.85% vs.51.1%,P < 0.05),and the incidence of clinically relevant pancreatic fistula(grades B and C)in the NIP group was significantly lower(4.6% vs.28.15%,P < 0.05),with a statistically significant difference.3.Compared to the DTMP group,the NIP group showed significantly lower incidence of postoperative delayed gastric emptying,as well as abdominal and pulmonary infections,with statistical significance(P<0.05).The NIP group also had significantly shorter surgical time,less intraoperative blood loss,and shorter hospital stay than the DTMP group,with statistical significance(P<0.05).However,there were no significant differences between the two groups in terms of rates of reoperation within one month,postoperative bile leakage,and postoperative bleeding(P>0.05).4.The results of univariate and multivariate analyses showed that a history of preoperative jaundice,serum albumin level <40g/L,pancreatic CT value <40,main pancreatic duct diameter <3mm,stent-to-mucosa anastomosis,and gastric or intestinal decompression time >7 days were independent risk factors for the occurrence of pancreatic fistula.Conclusion : 1.The novel invagination pancreaticojejunostomy technique is simple and remarkably effective,and its clinical application is safe and feasible.2.The novel invagination pancreaticojejunostomy technique significantly reduces the incidence of postoperative pancreatic fistula,postoperative intra-abdominal infection,postoperative pulmonary infection,and other serious postoperative complications.3.A history of preoperative jaundice,serum albumin level <40g/L,pancreatic CT value <40,main pancreatic duct diameter <3mm,method of duct-to-mucosa anastomosis,and gastrointestinal decompression time >7 days are independent risk factors for postoperative pancreatic fistula. |
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