胰十二指肠切除术改进胰肠及胃肠吻合方式52例观察

目的探讨胰十二指肠切除术改进胰肠及胃肠吻合方式对患者近期和远期并发症的影响。方法对52例行胰十二指肠切除术的患者进行消化道重建，方式为胰肠、胆肠和胃肠顺序。胰肠吻合在完成胰十二指肠切除后，游离胰腺残端2．5～3．0cm，将准备与胰腺吻合的空肠袢断端浆肌层剥除，制成黏膜瓣，长度与胰腺断面前后径相当，施行黏膜瓣覆盖胰腺断面的套叠式胰空肠端端吻合术；胃肠吻合是在胃或十二指肠球部与胰胆侧肠袢之间问置30cm空肠施行胃肠道重建。结果术后发生胰漏2例（3．8％），经充分引流并给予生长抑素、肠内营养等保守治疗愈合，无腹腔感染及大出血等严重并发症。术后随访3年，随访率为88．5％（46／52），术后半年95．0％（38／40）的患者消化吸收功能基本正常，营养状况良好，未发生逆行性胆管炎、胆汁反流性胃炎、胃肠吻合口溃疡。结论施行胰十二指肠切除消化道重建过程中，采用黏膜瓣覆盖胰腺断面的套叠式胰空肠端端吻合术有助于减少胰漏等近期并发症在胃或十二指肠球部与胰胆侧肠袢之间间置空肠，可减少胃肠道反流等远期并发症。

Modified pancreatico-jejunal and gastrointestinal anastomosis after pancreaticoduodenectomy in 52 patients

Objective To investigate the effect of modified panereatieo-jejunal and gastrointestinal anastomosis for short- and long-term complications after panereaticoduodenectomy. Methods Digestive tract was rebuilt in fifty-two patients undergoing pancreatieoduodeneetomy in the order of paneretieo-jejunal, biliary ductal junction and gastrointestinal anastomosis. After panereaticoduodenectomy, the pancreatic stump was freed from the surrounding vessels and structures for a length of 2.5-3.0 era. A jejunal loop was prepared for the panereatieo-jejunal anastomosis by removing the seromuseular layer where it would be anastomosed. The length of intestinal mueosal flap corresponded to anteroposterior diameter of pancreatic stump. An end to end pancreatico-jejunal anastomosis was then performed for covering surface of pancreatic stump with intestinal mueosal flap and duet-to-mucosal anastomosis. Gastrointestinal anastomosis was carried out in the 30 em between the gastric-renmant or duodenal bulb and pancreatic biliary side bowel loops. Results Two cases （3.8%） of pancreatie leakage were observed, and were cured by administration of adequate drainage, somatostatin, enteral nutrition and so on. Postoperative serious complications such as abdominal infection or heavy bleeding were not observed. For a three-year follow-up, the rate of generally normal digestion and absorption function was 95.0% （38/40）. All the patients were free from the long-term complications, like retrograde infection of biliary tract, bile reflux gastritis or gastrointestinal anastomotic ulcer. Conclusions Pancreatieo-jejunal invagination anastomosis may reduce short-term complications of potential anastomotic, covering surface of pancreaticstump with intestinal mucosal flap and duct-to-mucosal anastomosis in alimentary tract reconstruction. Jejunal interposition between the gastric-remnant or duodenal bulb and pancreatic biliary side bowel loops in the reconstruction of gastrointestinal tract can reduce the incidence of long-term complications caused by gastrointestinal reflux.