Analysis of the application and effectiveness of endoscopic nasal pancreatic duct methylene blue staining in pancreatic enucleation

Zhang Mengzhe; Zhang Zhengle; Li Hanjun; Rong Yuping; Zhu Zhongchao; Tao Jing

doi:10.3969/j.issn.1003-5591.2025.01.006

您当前的位置：

首页 >

文章列表页 >

Analysis of the application and effectiveness of endoscopic nasal pancreatic duct methylene blue staining in pancreatic enucleation

更新时间：2026-11-05

- Analysis of the application and effectiveness of endoscopic nasal pancreatic duct methylene blue staining in pancreatic enucleation
- J Abdominal Surg Vol. 38, Issue 1, Pages: 26-29(2025)
- 作者机构：
  
  武汉大学人民医院胰腺外科，湖北武汉 430060
- 作者简介：
  
  Tao Jing， Email：taojing@whu.edu.cn
- 基金信息：
- DOI：10.3969/j.issn.1003-5591.2025.01.006
  CLC： R657.5
- Received：23 October 2024，
  
  Published：22 February 2025
- 稿件说明：
移动端阅览
张孟哲,张正乐,李汉军等.经鼻胰管美蓝显影在胰腺肿瘤剜除术中的应用及效果分析[J].腹部外科,2025,38(01):26-29.

Zhang Mengzhe,Zhang Zhengle,Li Hanjun,et al.Analysis of the application and effectiveness of endoscopic nasal pancreatic duct methylene blue staining in pancreatic enucleation[J].J Abdominal Surg,2025,38(01):26-29.
张孟哲,张正乐,李汉军等.经鼻胰管美蓝显影在胰腺肿瘤剜除术中的应用及效果分析[J].腹部外科,2025,38(01):26-29. DOI： 10.3969/j.issn.1003-5591.2025.01.006.

Zhang Mengzhe,Zhang Zhengle,Li Hanjun,et al.Analysis of the application and effectiveness of endoscopic nasal pancreatic duct methylene blue staining in pancreatic enucleation[J].J Abdominal Surg,2025,38(01):26-29. DOI： 10.3969/j.issn.1003-5591.2025.01.006.

摘要

目的

探讨胰腺肿瘤剜除术术中经鼻胰管行美蓝显影的应用效果及可行性。

方法

回顾性分析自2020年5月至2024年9月在武汉大学人民医院胰腺外科行术中经鼻胰管美蓝显影的胰腺肿瘤剜除术18例病人的病历资料和随访结果。18例病人中，肿瘤位于胰头颈部15例，体尾部3例；肿瘤最大径为（2.3±0.7） cm，肿瘤边缘距离主胰管的最近距离为（2.2±0.6） mm，18例病人均术前经内镜下放置鼻胰管，术中胰腺肿瘤剜除后，经鼻胰管注入美蓝溶液，观察创面蓝染情况，根据胰液漏出部位选择合适的修补方式，记录分析术后近远期并发症，尤其关注术后胰瘘发生情况。

结果

术中注入美蓝溶液发现6例创面蓝染；按国际胰瘘研究组术后胰瘘标准，术后共有10例病人发生胰瘘、生化漏，其中生化漏7例，B级术后胰瘘3例，无C级术后胰瘘发生。

结论

经鼻胰管美蓝显影应用于胰腺肿瘤剜除术中，安全可行，有助于及时精准地发现肉眼难以观察的胰液漏出，并及时修补，从而降低以胰瘘为代表的术后并发症风险。

Abstract

Objective

To evaluate the feasibility and effectiveness of methylene blue staining via nasopancreatic tube during pancreatic enucleation.

Methods

A retrospective analysis was conducted on the medical records and follow-up data of 18 patients who underwent pancreatic enucleation with intraoperative methylene blue staining via nasopancreatic tube at the Pancreatic Surgery Department of Renmin Hospital of Wuhan University from May 2020 to September 2024. Among these patients，15 had tumors located in the pancreatic head and neck，and 3 in the body and tail.The maximum tumor diameter was 2.3±0.7 cm， and the shortest distance between the tumor margin and the main pancreatic duct was 2.2±0.6 mm. All patients had nasopancreatic tubes placed preoperatively under endoscopic guidance.During surgery，methylene blue solution was injected through the nasopancreatic tube after tumor enucleation to observe the staining of the pancreatic wound surface.Appropriate repair methods were selected based on the location of pancreatic juice leakage，and postoperative short-and long-term complications were recorded and analyzed，with a particular focus on the occurrence of postoperative pancreatic fistula（POPF）.

Results

Intraoperative injection of methylene blue solution revealed staining of the wound surface in 6 cases. According to the International Study Group on Pancreatic Fistula （ISGPF） criteria for POPF， a total of 10 patients experienced pancreatic fistula and biochemical leak postoperatively. Among these， there were 7 cases of biochemical leak and 3 cases of grade B POPF， without occurrences of grade C POPF.

Conclusion

The application of methylene blue staining via nasopancreatic tube during pancreatic enucleation is safe and feasible.It facilitates the timely and accurate detection of pancreatic juice leakage that may not be visible to the naked eye，enabling immediate repair and reducing the risk of postoperative complications， particularly pancreatic fistula.

关键词

Keywords

references

Kahl S ， Malfertheiner P . Exocrine and endocrine pancreatic insufficiency after pancreatic surgery ［J］. Best Pract Res Clin Gastroenterol ， 2004 ， 18 （ 5 ）： 947 - 955 . DOI： 10.1016/j.bpg.2004.06.028 http://dx.doi.org/10.1016/j.bpg.2004.06.028 .

Khe Tran TC ， van Lanschot JJ ， Bruno MJ ， et al . Functional changes after pancreatoduodenectomy：diagnosis and treatment ［J］. Pancreatology ， 2009 ， 9 （ 6 ）： 729 - 737 . DOI： 10.1159/000264638 http://dx.doi.org/10.1159/000264638 .

Schwarz JL ， Hogg ME . Current state of minimally invasive pancreatic surgery ［J］. J Surg Oncol ， 2021 ， 123 （ 6 ）： 1370 - 1386 . DOI： 10.1002/jso.26412 http://dx.doi.org/10.1002/jso.26412 .

史逸华，吉顺荣，徐晓武，等 . 保留功能的微创胰腺肿瘤剜除术技术要点及思考［J］. 外科理论与实践， 2022 ， 27 （ 1 ）： 14 - 18 . DOI： 10.16139/j.1007-9610.2022.01.004 http://dx.doi.org/10.16139/j.1007-9610.2022.01.004 .

Sauvanet A . Surgical complications of pancreatectomy ［J］. J Chir （Paris）， 2008 ， 145 （ 2 ）： 103 - 114 . DOI： 10.1016/s0021-7697（08）73718-9 http://dx.doi.org/10.1016/s0021-7697（08）73718-9 .

Dedieu A ， Rault A ， Collet D ， et al . Laparoscopic enucleation of pancreatic neoplasm ［J］. Surg Endosc ， 2011 ， 25 （ 2 ）： 572 - 576 . DOI： 10.1007/s00464-010-1223-7 http://dx.doi.org/10.1007/s00464-010-1223-7 .

Isla A ， Arbuckle JD ， Kekis PB ， et al . Laparoscopic management of insulinomas ［J］. Br J Surg ， 2009 ， 96 （ 2 ）： 185 - 190 . DOI： 10.1002/bjs.6465 http://dx.doi.org/10.1002/bjs.6465 .

Hirota M ， Kanemitsu K ， Takamori H ， et al . Local pancreatic resection with preoperative endoscopic transpapillary stenting ［J］. Am J Surg ， 2007 ， 194 （ 3 ）： 308 - 312 . DOI： 10.1016/j.amjsurg.2007.01.027 http://dx.doi.org/10.1016/j.amjsurg.2007.01.027 .

中华医学会外科学分会胰腺外科学组，中国研究型医院学会胰腺病专业委员会，中华外科杂志编辑部 . 胰腺术后外科常见并发症诊治及预防的专家共识（2017）［J］. 中华外科杂志， 2017 ， 55 （ 5 ）： 328 - 334 . DOI： 10.3760/cma.j.issn.0529-5815.2017.05.003 http://dx.doi.org/10.3760/cma.j.issn.0529-5815.2017.05.003 .

Bassi C ， Dervenis C ， Butturini G ， et al . Postoperative pancreatic fistula：an international study group （ISGPF） definition ［J］. Surgery ， 2005 ， 138 （ 1 ）： 8 - 13 . DOI： 10.1016/j.surg.2005.05.001 http://dx.doi.org/10.1016/j.surg.2005.05.001 .

Fernández-Cruz L ， Blanco L ， Cosa R ， et al . Is laparoscopic resection adequate in patients with neuroendocrine pancreatic tumors？［J］. World J Surg ， 2008 ， 32 （ 5 ）： 904 - 917 . DOI： 10.1007/s00268-008-9467-2 http://dx.doi.org/10.1007/s00268-008-9467-2 .

Kiely JM ， Nakeeb A ， Komorowski RA ， et al . Cystic pancreatic neoplasms：enucleate or resect？［J］. J Gastrointest Surg ， 2003 ， 7 （ 7 ）： 890 - 897 . DOI： 10.1007/s11605-003-0035-7 http://dx.doi.org/10.1007/s11605-003-0035-7 .

Wu JH ， Guo WY ， Li CQ ， et al . Laparoscopic enucleation of tumors embedded in the pancreatic head：safety and feasibility ［J］. Asian J Surg ， 2024 ： S1015-S9584（24）01985 - 7 . DOI： 10.1016/j.asjsur.2024.09.001 http://dx.doi.org/10.1016/j.asjsur.2024.09.001 .

Velanovich V . The use of tissue sealant to prevent fistula formation after laparoscopic distal pancreatectomy ［J］. Surg Endosc ， 2007 ， 21 （ 7 ）： 1222 . DOI： 10.1007/s00464-007-9282-0 http://dx.doi.org/10.1007/s00464-007-9282-0 .

Kuroki T ， Tajima Y ， Tsutsumi R ， et al . Inferior branch-preserving superior head resection of the pancreas with gastric wall-covering method for intraductal papillary mucinous adenoma ［J］. Am J Surg ， 2006 ， 191 （ 6 ）： 823 - 826 . DOI： 10.1016/j.amjsurg.2005.08.040 http://dx.doi.org/10.1016/j.amjsurg.2005.08.040 .

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Application outcomes of naso-pancreatic duct in patients with severe acute pancreatitis intraperitoneal infection complicated with pancreatic fistula

Efficacy of pre‑procedural magnesium sulfate in preventing post‑ERCP pancreatitis： a propensity score‑matched analysis

Application of a modified Chen's pancreaticojejunostomy to laparoscopic pancreaticoduodenectomy

Optimal drainage area of abdominal cavity after pancreatoduodenectomy： a prospective cohort study

Research advances of effects of pancreaticojejunostomy and its modifications on postoperative pancreatic fistula

Related Author

Chang Jian

Li Wei

Zhu Zhongchao

Zhu Kongfan

Hu Kaibing

Tian Yun

Yang Chunjian

Hu Gang

Related Institution

Department of Pancreatic Surgery， Renmin Hospital， Wuhan University

Department of General Surgery，the Second People's Hospital of Hefei

Department of Pancreatic Surgery， Union Hospital， Tongji Medical College， Huazhong University of Science and Technology

Department of Biliary and Pancreatic Surgery， the 2nd Hospital of Harbin Medical University

College of Clinical Medicine， North Sichuan Medical College， Sichuan Nanchong

AI问答

⁰