保留幽门的胰十二指肠切除胰胃吻合术(附5例报告)

目的探讨胰十二指肠切除保留幽门后消化道重建原位胰胃吻合、肠肠吻合、胆肠吻合的临床疗效。方法对5例壶腹周围肿瘤行胰十二指肠切除保留幽门后,采用原位吻合方式,即胰胃吻合、十二指肠—空肠吻合、肝总管—空肠吻合方式重建消化道。胰胃吻合于胃后壁直接切口,黏膜与胰管、胃浆基层与胰断端直接吻合。结果术后随访1个月~15个月,5例病人中,近期并发胃排空延迟(呕吐)1例(1/5),腹腔感染1例(1/5),无明显胰、胆瘘发生,无上消化道出血病例。远期无胰功能不足及胃肠溃疡等并发症发生。结论保留幽门原位消化道重建、胰胃吻合创伤小,术后恢复快,更符合生理机制,胆胰瘘发生率低,是胰十二指肠切除后消化道重建的优良术式。

PYLORUS-RETENTION PANCREATODUODENECTOMY AND PANCREATIC-GASTRIC ANASTOMOSIS

Objective To explore the pancreatic-gastric anatomosis in digestive reconstruction in the same position after pancreatoduodenectomy with pylorus retained. Methods 5 cases received pylorus-retention pancreatoduodencetomy around amulla. Anastomoses in the same position were used to reconstruct digestive tract. Different anastomoses were used, including pancreatic-gastric, duodenal-jejunal and hepatocystic-jejunal anastomoses. Results The 1 - 15 months of follow-up surveys showed that of the 5 cases, 1 case got gastric emptying and 1 case got abdominal infection. No pancreatic or biliary fistula or hemorrhage of upper digestive tract occurred, In the long term, no pancreatic insufficiency or gastrointestinal ulcers occurred. Conclusion Pylorus-retention digestive tract reconstruction and pancreatic-gastrlc anastomosis produce little trauma and few pancreatic-biliary fistula,and can be used effectively to reconstruct digestive tract after pancreatoduodenectomy.