胰十二指肠切除经肠系膜上血管蒂后间隙胰肠直接套入式吻合的临床研究

目的:探讨预防胰十二指肠切除术后胰肠吻合口漏的有效安全术式。方法:2003年1月～2006年6月共施行经肠系膜上血管蒂后间隙胰肠直接套入式吻合的胰十二指肠切除术43例,并与同期的56例传统的胰十二指肠切除术(Child)进行对比。结果:改良手术组43例患者,未发生胰肠吻合口漏,发生胆肠吻合口漏2例,经2～3周的充分引流治愈。腹腔感染2例,经抗感染及充分引流后治愈。胃应激性溃疡4例,经加大抑酸剂用量及应用凝血药物后治愈。传统手术组56例,发生不同程度的胰肠吻合口漏3例,腹腔引流液淀粉酶>9000IU/L,其中2例经应用生长抑素十四肽、静脉高营养及禁饮食,通畅的腹腔引流21～32d后治愈。1例82岁高龄患者死亡。其他术后并发症与改良手术组比较差异无统计学意义,P>0.05。结论:经肠系膜上血管蒂后间隙胰肠直接套入式吻合的胰十二指肠切除术对预防胰肠吻合口漏的发生有一定的意义,是治疗壶腹周围癌的安全有效术式,值得进一步应用研究。

Vaginated pancreaticojejunostomy in the approach of posterior to the root of superior mesenteric vessels

OBJECTIVE:To explore a safe and effective procedure to prevent pancreatic leakage after pancreaticoduodenectomy.METHODS:Forth-three cases of pancreaticoduodenectomy were performed with vaginated pancreaticojejunostomy from Jan.2003 to Jun.2006 in the approach of posterior to the root of superior mesenteric vessels.And compared to 56 cases of traditional pancreaticoduodenectomy(Child groups).RESULTS:There were no pancreatic leakage case in the modified group of 43 cases.Two cases hepaticojejunostomic leakage,and were cured through completely drainage 2 to 3 weeks.Two cases abdominal infection,and were cured through anti-infection and completely drainage.Four cases stress ulcer and cured through Losec and coagulant.There were 3 pancreatic leakage cases in the traditional groups of 56 cases.The pancreatic amylase of the abdominal drainage was more than 9 000 IU/L,2 cases were cured through Stilamin and intravenous nutrition and completely drainage after 21 to 32 days.One case of 82 yearsold died.The other complication was not significantly different from the modified group,P>0.05.CONCLUSION:The vaginated pancreaticojejunostomy is a safe and efficient procedure,and the pancreatic leakage can be prevented effectively and the cavity posterior to the root of superior mesenteric vessels could be eliminated.