胰十二指肠切除改良胰管空肠吻合预防胰瘘

目的: 分析胰十二指肠切除术(PD)胰管空肠端侧粘膜对粘膜及胰管空肠套入式吻合方式,以其预防术后胰瘘发生。 方法: 2003年1月～2007年1月回顾性分析25例PD的临床资料,残胰的重建方式分别按胰管空肠粘膜对粘膜套入式端侧吻合,胰管支撑管胰液体外引流。 结果: PD24例术后恢复顺利,未发生胰瘘;1例术后腹腔创面广泛渗血,多器官功能衰竭围手术期死亡,其余随访无远期并发症。 结论: PD胰管空肠端侧粘膜对粘膜套入式吻合有明显避免胰瘘及并发症的发生,真正临床应用价值有待更大量的对照随机前瞻性大样本研究才能作出正确可靠的评价。

Continuous Anastomosis of Pancreatic Duct and Jejunal Mucosa in Preventing Pancreatic Leakage after Pancreaticoduodenectomy

Objective: To explore the role of continuous anastomosis of pancreatic duct and jejunal mucosa in preventing pancreatic leakage after pancreaticoduodenectomy. Methods: Data from 25 patients who underwent pancreaticoduodenectomy with three-layer anastomosis of the pancreatic neck and jejunum between January 2003 and January 2007 were retrospectively investigated. The outer layer was created between the pancreatic capsule and the serosa of the jejunum; the middle layer was created between the pancreatic parenchyma and the seromuscular wall of the jejunum; the inner layer was placed between the pancreatic duct and a small opening in the antimesenteric border of the jejunal mucosa, with interrupted absorbable sutures. Results: Twenty-four patients recovered well, without pancreatic leakage or other serious complications. One patient suffered from extensive abdominal hemorrhage and died of multiple organ failure. Conclusion: Anastomosis of the pancreatic duct and jejunal mucosa with absorbable thread in duct-to-mucosa sutures is a safe procedure after pancreaticoduodenectomy and it prevents pancreatic leakage.