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首页> 外文期刊>Journal of hepato-biliary-pancreatic surgery >Novel interventional treatment technique for intractable pancreatic fistula due to dehiscence of pancreatico-jejunal anastomosis following pancreaticoduodenectomy.
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Novel interventional treatment technique for intractable pancreatic fistula due to dehiscence of pancreatico-jejunal anastomosis following pancreaticoduodenectomy.

机译：胰十二指肠切除术后因胰空肠吻合开裂而引起的顽固性胰瘘的新型介入治疗技术。

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摘要

Despite recent technological advances in the treatment of hepatobiliary pancreatic disease, intractable external pancreatic fistula is still a major critical complication after pancreaticoduodenectomy, and the treatment strategy is not well defined. We report here a case that was successfully treated by our novel interventional internal drainage technique. A 62-year-old woman underwent pylorus-preserving pancreaticoduodenectomy for carcinoma of the papilla of Vater, with reconstruction by a modified Child's procedure. One year later, she was readmitted to our hospital because of external pancreatic fistula. Both computed tomography and fistulography demonstrated a pancreatic fistula derived from dehiscence of the pancreatico-jejunal anastomosis. The pancreatic fistula persisted for 1 week with conservative management. Therefore, we performed repeated fistulography and cannulation, using two comparatively stiff guidewires introduced into the main pancreatic duct and stenotic anastomosed jejunal lumen, respectively, and we placed an endoprosthesis, using bilateral guidewires to connect the two lumens. Consequently, the pancreatic fistula was successfully closed within a few days. Our novel technique is simple, rapid, and not costly. Therefore, it should be considered an effective treatment strategy for persistent pancreatic fistula following pancreaticoduodenectomy that fails to respond to initial conservative management and an endoscopic approach. Also, this technique is applicable to other intractable fistulous situations.
机译：尽管在肝胆胰疾病的治疗方面有最新技术进展，但是顽固性胰外瘘仍是胰十二指肠切除术后的主要危重并发症，并且治疗策略尚不明确。我们在这里报告了通过我们的新型介入性内部引流技术成功治疗的病例。一名62岁的妇女因改良的Child手术而接受了保留幽门的胰十二指肠切除术，以治疗Vater的乳头状癌。一年后，她因胰外瘘再次入院。计算机体层摄影术和瘘管造影术均显示出胰腺空肠吻合口裂所致的胰瘘。胰瘘持续保守治疗1周。因此，我们使用分别插入到主胰管和狭窄吻合空肠腔的两条相对较硬的导丝进行了重复的瘘管造影术和插管术，并使用双侧导丝连接两个内腔放置了一个假体。因此，胰瘘在几天内成功闭合。我们的新技术简单，快速且不昂贵。因此，应该考虑对胰十二指肠切除术后持续性胰瘘进行有效的治疗策略，这种方法对最初的保守治疗和内窥镜治疗均无反应。而且，该技术适用于其他顽固性瘘管情况。

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