臨床外科73巻8号

2018年08月発行

特集 徹底解説！ 膵尾側切除を極める 各論：膵断端処理法

Stapler法—手術手技の工夫と術後膵液漏リスク因子の解析

著者： 杉本元一¹ 後藤田直人¹

所属機関： ¹国立がん研究センター東病院肝胆膵外科

ページ範囲：P.943 - P.947

【ポイント】
◆膵切離前に膵周囲を十分に剝離し，周囲組織を巻き込むことなくstaplerを挿入する十分なスペースを確保しておく．
◆Staplerによる膵切離の際は，膵被膜および膵実質に対し愛護的な操作が重要である．
◆厚い膵に対しては，staplerを使用した膵切離により，術後膵液漏の発生頻度が高くなる．
＊本論文中、［▶動画］マークのある図につきましては、関連する動画を見ることができます（公開期間：2021年8月末まで）．

参考文献

1）Pannegeon V, Pessaux P, Sauvanet A, et al：Pancreatic fistula after distal pancreatectomy：predictive risk factors and value of conservative treatment. Arch Surg 141：1071-1076, 2006

2）Sledzianowski JF, Duffas JP, Muscari F, et al：Risk factors for mortality and intra-abdominal morbidity after distal pancreatectomy. Surgery 137：180-185, 2005

3）Ferrone CR, Warshaw AL, Rattner DW, et al：Pancreatic fistula rates after 462 distal pancreatectomies：staplers do not decrease fistula rates. J Gastrointest Surg 12：1691-1697, 2008

4）Eguchi H, Nagano H, Tanemura M, et al：A thick pancreas is a risk factor for pancreatic fistula after a distal pancreatectomy：selection of the closure technique according to the thickness. Dig Surg 28：50-56, 2011

5）Zhang H, Zhu F, Shen M, et al：Systematic review and meta-analysis comparing three techniques for pancreatic remnant closure following distal pancreatectomy. Br J Surg 102：4-15, 2015

6）Diener MK, Seiler CM, Rossion I, et al：Efficacy of stapler versus hand-sewn closure after distal pancreatectomy（DISPACT）：a randomised, controlled multicentre trial. Lancet 377：1514-1522, 2011

7）Sugimoto M, Gotohda N, Kato Y, et al：Risk factor analysis and prevention of postoperative pancreatic fistula after distal pancreatectomy with stapler use. J Hepatobiliary Pancreat Sci 20：538-544, 2013

8）Bassi C, Marchegiani G, Dervenis C, et al：The 2016 update of the International Study Group（ISGPS）definition and grading of postoperative pancreatic fistula：11 Years After. Surgery 161：584-591, 2017

9）Nakamura M, Wakabayashi G, Miyasaka Y, et al：Multicenter comparative study of laparoscopic and open distal pancreatectomy using propensity score-matching. J Hepatobiliary Pancreat Sci 22：731-736, 2015

10）Okano K, Kakinoki K, Yachida S, et al：A simple and safe pancreas transection using a stapling device for a distal pancreatectomy. J Hepatobiliary Pancreat Surg 15：353-358, 2008

11）Nakamura M, Ueda J, Kohno H, et al：Prolonged peri-firing compression with a linear stapler prevents pancreatic fistula in laparoscopic distal pancreatectomy. Surg Endosc 25：867-871, 2011

12）Okano K, Oshima M, Kakinoki K, et al：Pancreatic thickness as a predictive factor for postoperative pancreatic fistula after distal pancreatectomy using an endopath stapler. Surg Today 43：141-147, 2013

13）Kawai M, Tani M, Okada K, et al：Stump closure of a thick pancreas using stapler closure increases pancreatic fistula after distal pancreatectomy. Am J Surg 206：352-359, 2013

14）Hamilton NA, Porembka MR, Johnston FM, et al：Mesh reinforcement of pancreatic transection decreases incidence of pancreatic occlusion failure for left pancreatectomy：a single-blinded, randomized controlled trial. Ann Surg 255：1037-1042, 2012

15）Jang JY, Shin YC, Han Y, et al：Effect of Polyglycolic Acid Mesh for Prevention of Pancreatic Fistula Following Distal Pancreatectomy：A Randomized Clinical Trial. JAMA Surg 152：150-155, 2017

16）Kawai M, Hirono S, Okada K, et al：Randomized Controlled Trial of Pancreaticojejunostomy versus Stapler Closure of the Pancreatic Stump During Distal Pancreatectomy to Reduce Pancreatic Fistula. Ann Surg 264：180-187, 2016