预防性胆-胰双分流：胰十二指肠切除术后并发症防控的理念革新与临床转化

Prophylactic dual biliary-pancreatic diversion: a conceptual and translational innovation in preventing postoperative complications after pancreaticoduodenectomy

摘要:

胰十二指肠切除术是胰腺外科风险最高、并发症最复杂的手术之一，其中临床相关胰瘘仍是影响术后恢复与预后的关键问题。近年来的研究显示，仅依靠改变胰肠吻合方式难以持续降低胰瘘发生率。复旦大学附属中山医院胰腺外科提出并研发的“预防性胆-胰双分流系统”，通过术中同步引流胆汁与胰液，实现“减压+分隔”的双重保护机制，旨在从源头上阻断胰液被激活的病理链条，降低吻合口并发症发生风险。本文系统阐述了该系统的设计原理、临床应用与早期试验结果，并结合多中心随机对照研究进展，探讨其适应证界定、术中操作要点、外引流管理及患者依从性等关键环节。同时，文章展望了基于风险分层、智能引流、抗菌管理和材料学创新的未来发展方向。作为一种兼具理念创新与工程转化的防瘘策略，预防性胆-胰双分流系统有望成为防控胰十二指肠切除术后并发症的新范式。

Abstract:

Pancreaticoduodenectomy (PD) remains one of the most complex and high-risk procedures in abdominal surgery, with clinically relevant postoperative pancreatic fistula (CR-POPF) being a significant determinant of morbidity and mortality. Recent evidence suggests that merely modifying the pancreatoenteric anastomosis technique fails to achieve a consistent reduction in fistula incidence. The Department of Pancreatic Surgery at Zhongshan Hospital, Fudan University, has developed a prophylactic dual biliary-pancreatic diversion system that simultaneously drains bile and pancreatic juice during PD. This system provides dual protection through "decompression and separation," preventing premature activation of pancreatic enzymes and reducing anastomotic stress. This article introduces the system's conceptual framework, design principles, and clinical application, summarizes ongoing multicenter randomized controlled trials, and discusses key issues, including indication selection, intraoperative management, external drainage care, and patient compliance. Furthermore, it outlines future directions in risk stratification, antimicrobial stewardship, intelligent drainage, and biomaterial innovation. As a conceptual and translational advance, this dual diversion strategy may redefine the paradigm of postoperative complication prevention after PD.