胰十二指肠切除术后胰瘘与胰肠吻合方法的关系

目的：探讨胰十二指肠切除术后胰瘘与胰肠吻合方法的关系。方法：比较两种不同的胰腺吻合方法－传统的胰肠套入式双层吻合（69例）与改良的胰肠套入式单层吻合（40例）术后胰瘘的发生情况，并对其机理进行探讨。结果：胰肠套入式双层吻合组术后发生胰瘘6例（8.7%)，其中4例经保守治疗后愈，1例再次手术引流，1例继发腹腔内大出血死亡；胰肠套入式单层吻合组术后无胰瘘发生。结论：胰十二指肠切除术后胰瘘的发生与胰肠吻合方法有关，胰肠套入式单层吻合是一种安全、实用的胰肠吻合方法。传统的胰肠套入式双层吻合术后胰瘘的发生主要与双层吻合时胰腺及其被膜易被撕裂，吻合口两端组织血运不佳以及双层吻合之间存在的潜在间隙可使沿缝针（线）裂隙外渗的胰液在吻合层面间积聚有关。

The currelation between pancreatic fistula and the methods of pancreatoenterostomy after pancreatoduodenectomy

Objective: The currelation between pancreatic fistula and the methods of pancreatoenterostomy after pancreatoduodenectomy. Method: The pancreatic fistula after coventional terminoterminal double-layered anastomosis in pancreatoenteric reconstruction in 69 cases (group A) and improved single-layered intussuscepted anastomosis in 40 cases (group B) were observered and the mechanism was evaluated. Result:6 cases of pancreatic fistula in group A (8.7%). 4 of those were cured using conservative treatment. 1 of those required second operative drainage. 1 of those was died of secondary hemorrhage in abdominal cavity; pancreatic fistula did not happen in group B. Conclusion:The occurence of postoperative pancreatic fistula is mainly related to the methods of pancreatoenterostomy. The single-layered intussuscepted anastomosis is safe and practical. The pancreatic fistula after conventional terminoterminal double-layered is related to pancreatic tear and pancreatic fluid leaking and accumulating in the roomage of terminoterminal double-layered anastomosis and blood supply in two sides of anastomotic stoma being deficient.