胰十二指肠切除术后胰胃吻合术的临床观察

目的总结胰十二指肠切除术后胰胃吻合术的临床应用经验。方法回顾性分析本院2007年5月至2010年12月间接受胰十二指肠切除术后胰胃吻合术16例患者的临床资料。全组患者接受将胰腺残端套入胃后壁方式吻合,采用术后检测引流液淀粉酶浓度方法诊断是否出现胰瘘。结果16例患者手术均顺利完成,平均手术时间（361．1±82．4）min,术中平均输血量（702．5±517．8）ml;术后住院时间平均（19．5±10．9）d;术后并发症3例（18．8％）,其中胰瘘并腹腔积液、腹腔出血1例,胰腺残端出血1例,切口感染1例。无住院期间因手术死亡病例。结论胰十二指肠切除术时,根据患者的具体情况合理地选择胰胃吻合是可行及安全的。     

胰胃吻合术在胰十二指肠切除术中的应用

目的：探讨胰胃吻合术（PG）在胰十二指肠切除术（PD）中的临床应用。方法：回顾性分析2010年12月—2012年12月期间50例PD后行PG患者的临床资料。分析术后胰瘘与其他并发症的发生情况,并分析术中、术后情况及术后腹腔引流液淀粉酶浓度与胰瘘发生的关系。结果：50例手术均顺利完成,术后胰瘘发生率36.0%（18/50）,其他并发症发生率为20.0%（10/50）。全组3例死亡,余患者治愈出院。统计分析显示,胰瘘的发生与患者年龄无关（P>0.05）,B, C级胰瘘患者的住院时间明显长于A级胰瘘或无胰瘘患者（均P<0.05）,术中出血量越大或术后腹腔引流液淀粉酶浓度高,胰瘘的发生几率或级别越高（均P<0.05）。结论：PG是PD后消化道重建的安全有效方式,可降低胰瘘的发生率;胰瘘并发腹腔出血、腹腔脓肿等可考虑外科干预。

     

Pancreaticogastrostomy compared with pancreaticojejunostomy after pancreaticoduodenectomy.

OBJECTIVE: To assess the safety of the pancreatic anastomosis after pancreatico-duodenectomy (PD). DESIGN: Non-randomized prospective trial in consecutive patients. SETTING: University hospital. SUBJECTS: 171 consecutive patients with resectable periampullary cancer (80%) or intractable pain due to chronic pancreatitis (20%) undergoing PD. INTERVENTIONS: Pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG). MAIN OUTCOME MEASURES: Mortality and morbidity rates due to anastomotic leak following PJ and PG. RESULTS: 91 PJ and 80 PG patients were comparable for age, gender, total bilirubin, ASA grading, indication for PD, operating time, pancreas texture, blood loss and replacement. The rate of pancreatic fistula was significantly higher in PJ patients (13%) than in PG patients (3.7%) (12 vs. 3, p = 0.029). Overall death rate was significantly higher after PJ (12%) than after PG (3.7%) (11 vs. 3, p = 0.047). Fatal outcome due to pancreatic leak (3 vs. 1, p = 0.83) and other death rates (8 vs. 2, p = 0.14) were not significantly different in PJ and PG groups, respectively. CONCLUSION: PJ was associated with significantly higher pancreatic leak rate than PG. However, there was no statistically significant difference in mortality rates directly related to pancreatic leak.     

Pancreaticogastrostomy after pancreaticoduodenectomy without suturing the pancreas

Surgery Today - The aim of the present paper was to describe a new and easy technique for performing pancreaticogastrostomy (PG) through simple pancreatic invagination by a single binding suture...     

胰十二指肠切除术胰肠、胰胃两种吻合方式的Meta分析

目的 比较胰十二指肠切除术后采用胰胃吻合术与采用胰空肠吻合术在围手术期死亡率、术后并发症发生率、术后胰瘘、胃排空延迟、出血、腹腔积液、二次手术等方面有无明显差异.方法 计算机检索PubMed、Cochrane Library、Medline、Embase等数据库,同时根据以上检索所得文献的参考文献进行扩大检索.使用Jadad法进行质量评价,采用Cochrane协作网提供的RevMan5.2.7统计软件进行Meta分析.结果 共纳入8项研究,共计1211例病人.结果显示,胰胃吻合组（PG）与胰空肠吻合组（PJ）相比,在围手术期并发症发生率、围手术期死亡率、胃排空延迟、出血以及二次手术方面并差异无统计学意义.而在术后胰瘘及腹腔积液方面,PG组优于PJ组,差异具有统计学意义.结论 胰胃吻合术的安全性不亚于胰空肠吻合术,并可在一定程度上降低术后胰瘘以及腹腔积液的发生率.但是尚需要更多相关的高质量临床研究,以进一步对PG及PJ两种术式进行比较.     

Pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy: critical analysis of prospective randomised trials

This is a critical analysis of prospective randomised trials that compare pancreatic reconstruction techniques with the stomach and the intestine, after pancreaticoduodenectomy. A questionnaire with questions from the Evidence Based Medicine Centre of Oxford University (PICO analysis) was used, following the criteria for the evaluation of randomised prospective studies for surgical interventions of the McMaster University in Ontario. It was found that the studies differed in methodological aspects, the most important being the lack of a uniform definition of a pancreatic fistula. The techniques for performing pancreaticogastrostomy and pancreaticojejunostomy were not homogeneous. There were no differences in the percentage of pancreatic fistula in three of these studies; one which modified the pancreaticogastrostomy technique had more favourable results. New comparative studies should use new definitions of the complications of pancreaticoduodenectomy and standardise the pancreatic reconstruction technique.     

胰十二指肠切除术后应用胰胃吻合与胰空肠吻合的Meta分析

目的 评价胰十二指肠切除术后胰胃吻合术与胰空肠吻合术的疗效.方法 计算机检索Cochrane Library（2014年第5期）、PubMed（1978年1月至2014年5月）、EMBASE（1966年1月至2014年5月）、SCI（1961年1月至2014年5月）、中国生物医学数据库（CBM）（1978年1月至2014年5月）、中国期刊全文数据库（CNKI）（1994年1月至2014年5月）,维普（1989年1月至2014年5月）和万方数据库（1998年1月至2014年5月）,同时在Google搜索引擎进行检索,并追查纳入研究参考文献,收集胰十二指肠切除术后胰胃吻合术与胰空肠吻合术的所有随机对照试验.根据Cochrane协作网推荐的“风险评估工具”进行偏倚风险评估,用RevMan5.2软件进行统计学分析.结果 纳入7项随机对照试验,共1 121例患者.Meta分析结果显示,与胰空肠吻合组相比,胰胃吻合组能降低胰十二指肠切除术后胰瘘发生率（RR=-0.56;95％ CI：0.41～0.75; P=-0.0001）、胆漏发生率（RR=0.43;95％ CI：0.19～ 0.95;P=-0.04）腹腔内多发并发症（OR=-0.26; 95％ CI：0.12 ～ 0.56;P=-0.0007）和腹腔内积液的发生（OR=-0.54;95％ CI：0.38～ 0.77;P=0.0005）,但两者在术后并发症、胃排空延迟、围手术期病死率方面差异均无统计学意义.结论 目前随机对照试验研究显示胰十二指肠切除术后消化道重建胰胃吻合术优于胰空肠吻合术.     

Pancreaticogastrostomy decreased relaparotomy caused by pancreatic fistula after pancreaticoduodenectomy compared with pancreaticojejunostomy

HYPOTHESIS: Pancreaticogastrostomy (PG) is associated with a lower relaparotomy rate following pancreaticoduodenectomy (PD) than pancreaticojejunostomy (PJ). DESIGN: Retrospective clinical trial. SETTING: Department of digestive surgery and transplantation. PATIENTS: Between 1987 and 2001, 250 consecutive patients underwent PD in our institution. Among them, 83 patients underwent PJ and 167, PG. MAIN OUTCOME MEASURES: Preoperative clinicopathological features, intraoperative parameters, in-hospital mortality, postoperative morbidity, pancreatic fistula (PF), relaparotomy rates, and length of hospital stay were analyzed and compared between 2 reconstructive methods, PJ and PG, after PD. RESULTS: The morbidity rate, including PF, was lower in the PG group (38.3%) than in the PJ group (53.0%; P =.02). The mortality rate did not differ between the PG group (2.9%) and PJ group (2.4%). Conversely, the incidence of PF and the mean +/- SD length of hospital stay were significantly lower in the PG group (2.3% and 17.2 +/- 7.7 days) than in the PJ group (20.4% and 23.3 +/- 11.7 days; P<.001 for both variables). Moreover, the overall relaparotomy rate was significantly lower in the PG group (4.7%) than in the PJ group (18.0%; P =.001). Nine (52.9%) of 17 patients with PF in the PJ group underwent relaparotomy. These 9 patients underwent subsequent completion pancreatectomy (n = 7) or removal of peripancreatic necrotized tissue (n = 2) with a postoperative mortality rate of 22.2%. However, no patient required relaparotomy for PF in the PG group because medical therapy succeeded in all 4 patients with PF. Moreover, no mortality related to PF occurred in the PG group. CONCLUSION: The PG procedure is a safe method of reconstruction after PD, with a significantly lower rate of PF and relaparotomy.     

Pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy: a meta-analysis of randomized controlled trials

Background

The best reconstruction method for the pancreatic remnant after pancreaticoduodenectomy remains debatable. We aimed to investigate the perioperative outcomes of 2 popular reconstruction methods: pancreaticogastrostomy and pancreaticojejunostomy.

Data Sources

Randomized controlled trials comparing pancreaticogastrostomy versus pancreaticojejunostomy were identified from literature databases (MEDLINE/PubMed, EMBASE, Web of Science, Cochrane Library).The meta-analysis included 8 studies: 607 patients who underwent pancreaticogastrostomy and 604 who underwent pancreaticojejunostomy. Postoperative pancreatic fistula and intra-abdominal fluid collection rates were significantly lower after pancreaticogastrostomy compared with pancreaticojejunostomy. No statistically significant differences were found in the incidence of delayed gastric emptying, biliary fistula, hemorrhage, reoperation, wound infection, overall morbidity, mortality, and length of hospital stay.

Conclusions

Our meta-analysis suggests that pancreaticogastrostomy not only reduces the rate of postoperative pancreatic fistula but also decreases its severity. Pancreaticogastrostomy is associated with a lower rate of intra-abdominal fluid collection. Our results suggest that pancreaticogastrostomy should be the preferred reconstruction method.     

Pancreaticogastrostomy after subtotal pancreatectomy for cancer

BACKGROUND: Failure of the pancreaticodigestive anastomosis after pancreatoduodenectomy is still a major clinical problem. Pancreaticogastrostomy has recently been suggested to be associated with a low risk of leakage. The aim of this report was to add to previously reported experience. METHODS: Data on the postoperative course were prospectively registered in 19 patients operated on with subtotal pancreatectomy because of periampullary cancer. They all had a duct-to-mucosa pancreaticogastrostomy. RESULTS: There were no recognizable leakages from the pancreaticogastrostomy. However, the overall postoperative complication rate was 47% (9/19), the most common complications being delayed gastric emptying (26%, 5/19), wound infection (21%, 4/19), and wound rupture (11%, 2/19). Excluding delayed gastric emptying, the rate of intra-abdominal complications was 16% (3/19). There was 1 in-hospital death. CONCLUSION: The results support the opinion that pancreaticogastrostomy can be done with a low risk of leakage. Copyright Copyright 1999 S.Karger AG, Basel     

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胰十二指肠切除术后胆管炎 (ｃｈｏｌａｎｇｉｔｉｓｆｏｌｌｏｗｉｎｇｐａｎ ｃｒｅａｔｉｃｏｄｕｏｄｅｎｃｅｔｏｍｙ ,ＣＰＤ)是一个易被人们忽视的少见并发症。与常见的急性胆管炎相比 ,ＣＰＤ的症状较轻 ,加之接受了对机体影响较大的胰十二指肠切除术 (ＰＤ) ,故难以推测这些不适的感觉究竟是由何种原因所致。ＣＰＤ的确切发生率尚难以估计 ,常需对ＰＤ术后病人长期随访及仔细观察方可注意到它的存在。据美国哈佛医学院医疗中心的统计 ,其发病率为 5 % ;日本全国的统计资料显示 ,如将轻症ＣＰＤ包括在内 ,其发生率约为 3 0 %。国内…     

Complications after pancreaticoduodenectomy

The most frequent complications after pancreaticoduodenectomy are analysed in this review. These include, delayed gastric emptying, pancreatic fistula, post-operative bleeding, and the complications after vascular reconstruction in the cases of locally extended pancreatic cancer. For this, randomised prospective studies, systematic meta-analyses and clinical guidelines on the definition, clinical severity grade and treatment of these complications have been evaluated.     

Pancreaticogastrostomy: a novel application after central pancreatectomy

BACKGROUND: Limited middle segment pancreatectomy, or central pancreatectomy, has been described for sparing normal pancreatic tissue during resection of benign neoplasms of the pancreatic neck. Anatomic reconstruction after central pancreatectomy has been reported in other series with creation of a Roux-en-Y loop of jejunum for a mucosa-to-mucosa pancreaticojejunostomy. STUDY DESIGN: Hospital charts and outpatient records were reviewed for 12 consecutive patients undergoing central pancreatectomy from August 1999 to November 2002. RESULTS: We performed central pancreatectomy with pancreaticogastrostomy in 12 patients: 5 with serous cystadenomas, 6 with mucinous cystadenomas, and 1 with neuroendocrine tumor. All tumors were located in the body or neck of the pancreas, measuring a mean +/- standard deviation (SD) of 2.5 +/- 1.2 cm. Median postoperative hospital stay was 6.5 days (range 5 to 15 days). There were no intraoperative complications. Perioperative complications included two urinary tract infections and one readmission for acute pancreatitis. There were no pancreatic leaks or fistulas in this series. Two of the 12 patients experienced endocrine insufficiency with elevated glycosylated hemoglobin levels during outpatient followup. None of the 12 patients experienced exocrine insufficiency. CONCLUSIONS: Central pancreatectomy with pancreaticogastrostomy reconstruction is safe and technically advantageous over Roux-en-Y pancreaticojejunostomy, and should be considered a safe reconstruction technique after central pancreatectomy for benign disease.     

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胰部分切除或全胰切除均可发生吻合口溃疡 (ａｎａｓｔｏ ｍｏｔｉｃｕｌｃｅｒａｔｉｏｎ) ,属胰腺切除的远期并发症 ,吻合口溃疡又称边缘溃疡 (ｍａｒｇｉｎａｌｕｌｃｅｒａｔｉｏｎ)。为了防止吻合口溃疡发生 ,传统的胰腺切除手术往往附加远端胃切除术或迷走神经切断术。但 5 0 %以下的胃切除不足以预防溃疡的发生。因此 ,文献常有胰十二指肠切除后并发边缘溃疡的报告。1　发病率复习近几十年文献 ,胰部分切除或全胰切除后吻合口溃疡的文献报道较少。其准确的发生率尚未明了 ,究其原因可能与此并发症并非十分常见有关。另外 ,相当部分病…     

胰十二指肠切除术后胰瘘的防治体会

目的分析胰十二指肠切除术后胰瘘的防治措施,以减少胰十二指肠切除术后并发症发生率。方法2001年1月至2005年12月对106例患者行胰十二指肠切除术,其中常规胰十二指肠切除术87例,保留幽门的胰十二指肠切除术4例,扩大胰十二指肠切除术15例。结果术后共出现胰瘘11例(10.4%),胰腺空肠端端套入式吻合、胰腺空肠端侧套入式吻合、胰管空肠黏膜吻合三种吻合方式胰瘘发生率分别为9.6%、12.9%和8.7%。术后平均胰瘘持续时间为(14.7±4.5)d。所有胰瘘患者均应用生长抑素类药物抑制胰腺外分泌治疗。结论防治胰十二指肠切除术后胰瘘的关键是改善胰肠吻合口的质量和保持引流通畅。术后应用生长抑素类药物有助于胰瘘的愈合。