捆绑式胰肠吻合术在胰十二指肠切除术中的应用

目的 介绍彭氏捆绑式胰肠吻合术在胰十二指肠切除术中的应用。方法 总结1996年12月至2001年12月200例彭氏捆绑式胰肠吻合术的临床应用和研究结果。吻合口针孔渗漏、吻合口间隙渗漏、空肠内高压、吻合口张力大和吻合口血供欠佳等往往导致胰肠吻合漏的发生。彭氏捆绑式胰肠吻合术就是针对上述胰肠吻合口漏的主要原因而设计的。结果 彭氏捆绑式胰肠吻合术在吻合时胰断端与肠黏膜缝合缝针不穿透浆肌层,这消除了线周间隙的渗漏,继而环绕空肠浆肌鞘和胰腺同轴捆绑使两者紧贴、不仅消除间隙、而且加速愈合,覆盖胰腺的空肠黏膜被破坏后有扩大愈合面大的作用,捆绑远端空肠保留血供避免捆绑远端空肠浆肌鞘坏死,术中立即测试吻合口的密封性和可靠性确保吻合口不漏。结论 彭氏捆绑式胰肠吻合术能够避免和减少胰肠吻合口漏的发生。

Effect of binding pancreaticojejunotomy in prevention of post-operational anastomotic leakage: a clinical study of 200 cases

OBJECTIVE: To explore the effect of Peng's binding pancreaticojejunotomy (PBPJ) in prevention of pancreaticojejunal anastomotic leakage. METHODS: From 1996 to 2001, 200 patients, 139 males and 61 females, aged 32 approximately 80, with carcinomas of head of pancreas, ampulla, bile duct, duodenal papilla, descending partof duodenum, gallbladder, and body of pancreas, chronic pancreatitis, polyp of lower segment of bile duct, and gastric carcinomas that invaded the head of pancreas or recurred after operation, lithiasis of pancreatic duct, and islet cell carcinoma, underwent Peng's binding pancreaticojejunotomy, devised to prevent pancreaticojejunal anastomotic leakage from the needle holes of stoma, interspace between jejunal mucosa and pancreas, high pressure of jejunum, high tension and blood circulation deficiency of pancreaticojejunal stoma, etc. The clinical data were collected and analyzed. RESULTS: While the cut end of jejunum was sutured to the pancreatic remnant the needle only penetrated the jejunal mucosa without causing a needle hole on the surface of the stoma. After the remnant of pancreas was inserted into the jejunal cavity, a piece of cat gut was bound around the entire jejunal serous muscular sheath and the pancreatic remnant so as to make them stick to each other closely. No pancreatic leakage occurred among these 200 cases after operation. CONCLUSION: The PBPJ procedure can definitively avoid anastomotic leakage following pancreatoduodenectomy.