胰肠吻合方式与胰漏发生关系的研究

Incidence of pancreatic leakage in pancreaticojejunostomy following pancreaticodudenectomy

目的探讨胰十二指肠切除术胰肠吻合方式与胰漏发生的关系,以寻找预防胰漏的办法。方法2001年1月至2005年12月行胰十二指肠切除术胰肠吻合106例。其中行胰腺空肠端端套入吻合52例,胰腺-空肠端侧套入吻合31例,胰管与空肠黏膜吻合23例;胰管支撑胰液内引流101例,胰管支撑胰液外引流5例。所有病例均放置T管。结果术后出现胰漏11例,占10.4%,其中胰腺空肠端端吻合5例(9.6%),胰腺空肠端侧吻合4例(12.9%),胰管空肠黏膜对黏膜吻合2例(2/23);胰管内放置支撑管胰液内引流101例、外引流5例,三种胰肠吻合方式的胰漏发生率差异无显著性意义(P>0.05),显示胰肠吻合方式与胰漏的发生无相关性。结论同一种吻合方式并不适用于所有病人,熟练掌握操作技术,积累丰富的临床经验,并根据具体情况选择相应的处理方法,才能将胰漏的发生率降到最低程度。

Objective To evaluate the possible difference of pancreatic leakage relative to various methods of pancreatico-jejunal reconstruction. Methods The clinical data of 106 cases of pancreaticodudenectomy performed between January 2001 and December 2005 was analyzed retrospectively. Fifty-two cases were performed pancreatico-jejunal end-to-end anastomosis. Thirty one cases were performed end-to-side anastomosis and 23 cases were performed end-to-side ＂mucosa-tomucosa＂ anastomosis. Five cases and 101 cases were performed external and internal transanastomotic drainage respectively. T-tube drainages were used in all cases. Results The overall incidence of pancreatic fistula was 10. 4%. The leakage rate following end-to-end anastomois was 9. 6%. The leakage rate of end-to-side anastomois was 12. 9%, and that of mucosa-to-mucosa anastomois was 8.70%. Five cases of external drainage did not complicated with pancreatic leakage. The results showed that there were no significant difference of incidences of pancreatic fistula among the three methods of pancreatico-jejunal reconstruction（ P 〉 0. 05）. Conclusion The same one method of pancreatico-jejunal reconstruction is not suitable for all cases. Surgeon＇ s experience seems to be an important factor. To decrease of the incidence of pancreatic leakage needs to choose one method suitable for the corresponding cases.