Abstract

Purpose

Multiple attempts have been made to manage the pancreatic stump and the pancreatic duct in order to reduce the rate of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD), however radiofrequency-based technologies could help to achieve this goal. Previous encouraging clinical and experimental results support the use of endoluminal thermal ablation (ETHA) of the main pancreatic duct to reduce pancreatic exocrine secretion and hence POPF. We here describe our initial clinical experience with ETHA of the main pancreatic duct in two cases at high risk of POPF.

Methods

Two cases underwent PD for malignancy with a high risk of POPF (adenocarcinoma, obese patients, surgical difficulties with heavy intraoperative blood loss, soft pancreas or walled-off pancreatitis and a tight small pancreatic main duct). In both cases, ETHA of the main pancreatic duct was conducted intraoperatively just before Blumgart-type pancreatic-jejunal anastomosis using a ClosureFast catheter (Medtronic, Mansfield, MA, USA) normally used for varicose vein treatment (therefore an off-label use).

Results

Although a clear radiological POPF was detected in the second case, the clinical postoperative course in both cases was uneventful. Little pancreatic fluid collected in the abdominal drainage with low levels of amylase enzyme, confirming low exocrine pancreatic function. No other procedure-related complications were detected.

Conclusion

Endoluminal thermal ablation of the main pancreatic duct may be a feasible and safe technique to reduce the adverse effects of POPF after PD.

中文翻译：

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临床病例报告：胰十二指肠切除术后胰瘘高危患者主胰管腔内热消融

摘要

目的

为了降低胰十二指肠切除术 (PD) 术后胰瘘 (POPF) 的发生率，已经进行了多次尝试来管理胰残端和胰管，但是基于射频的技术可以帮助实现这一目标。先前令人鼓舞的临床和实验结果支持使用主胰管的腔内热消融 (ETHA) 来减少胰腺外分泌，从而减少 POPF。我们在这里描述了我们在两个 POPF 高风险病例中使用主胰管 ETHA 的初步临床经验。

方法

2 例因具有高 POPF 风险的恶性肿瘤（腺癌、肥胖患者、术中大量失血的手术困难、软胰腺或有围壁的胰腺炎和狭窄的小胰主管）接受了 PD。在这两种情况下，主胰管的 ETHA 在术中使用通常用于静脉曲张治疗的 ClosureFast 导管（美敦力，曼斯菲尔德，马萨诸塞州，美国）在 Blumgart 型胰空肠吻合术之前进行（因此标签外使用）。

结果

尽管在第二个病例中检测到明确的放射学 POPF，但两个病例的临床术后过程都很顺利。腹部引流中收集到的胰液很少，淀粉酶水平低，证实胰腺外分泌功能低。未检测到其他与手术相关的并发症。

结论

主胰管腔内热消融可能是一种可行且安全的技术，可减少 PD 后 POPF 的不良反应。