胰十二指肠切除术中三种不同方式胰肠吻合的疗效比较

目的 比较胰十二指肠切除术中采用套入式胰肠端端吻合、套入式端侧胰肠吻合及胰管对黏膜端侧胰肠吻合等三种不同方式的胰肠吻合的临床疗效. 方法 回顾性分析采用胰十二指肠切除术治疗52例胰头、壶腹周围癌患者的临床资料,分析三种不同方式胰肠吻合的胰漏发生率、手术时间、手术出血量及术后并发症. 结果 套入式端端胰肠吻合25例,套入式端侧胰肠吻合16例,胰管对黏膜端侧胰肠吻合11例;手术时间4～7.15 h,胰管对粘膜端侧胰肠吻合手术时间短,各类围手术期并发症共18例,各种术后远期并发症10例.平均住院时间为（19.32±5.45）d,围手术期死亡共2例. 结论 套入式端端胰肠吻合、套入式端侧胰肠吻合以及胰管对粘膜端侧胰肠吻合均为手术切除后常用的吻合方式,吻合口漏是胰十二指肠切除手术后的严重并发症,根据术中情况决定吻合方式是最佳的手段.

Clinical effect of three different pancreaticojejunostomy in Whipple

Objective To investigate the clinical results of end-to-end invagination pancreaticojejunostomy.end-to-end invagination pancreaticojejunostomy and duct-to-mucosa pancreaticojejunostomy of pancreaticoduodencetomy of patients with pancreatic and periampullary carcinoma. Methods Fifty-two patients underwent different pancreaticoduodenectomy in our hospital from August 1995 to July 2006 were collected and analyzed retrospectively.The incidence of pancreatic leakage,operation time,the blood loss and the postoperative complications were analyzed. Results Twenty-five patients received end-to-end invagination pancreaticojejunostomy.Sixteen patients received end-toside invagination pancreaticojejunostomy.Eleven patients received end-to-side pancreaticojejunal mucosa-mucosa anastomosis.The operation time of the duct-to-mucosa pancreaticojejunostomy was shorter than the two of the others(4 ～7.15 h).The perioperative comphcations occurred in 18 cases and the long-term postoperative complications occurred in 10 cases.The average length of stay in hospital was(19.32 ±5.45)days.Two cases died during perioperative period. Conclusion End-to-eed invagination pancreaticojejunostomy,end-to-side invagination pancreaticojejunostomy and end-to-side pancreaticojejunal mucosa-mucosa anastomosis are all common anastomosis methods.Pancreatic leakage is a serious postoperative complication.The selection of anastomosis method is based on the condition during operation.