Pancreatic fistula after pancreaticoduodenectomy:A comparison between the two pancreaticojejunostomy methods for approximating the pancreatic parenchyma to the jejunal seromuscular layer:Interrupted vs continuous stitches

AIM： The purpose of this study is to find a better operative technique by comparing interrupted stitches with continuous stitches for the outer layer of the pancreaticojejunostomy, i.e. the stitches between the stump parenchyma of the pancreas and the jejunal seromuscular layer, and other risk factors for the incidence of pancreatic leakage.METHODS： During the period January 1997 to October 2004, 133 patients have undergone the end-to-side and duct-to-mucosa pancreaticojejunostomy reconstruction after pancreaticoduodenectomy with interrupted suture for outer layer of the pancreaticojejunostomy and 170 patients with a continuous suture at our institution by one surgeon.RESULTS： There were no significant differences between the two groups in the diagnosis, texture of the pancreas, use of octreotide and pathologic stage. Pancreatic fistula occurred in 14 patients （11%） among the interrupted suture cases and in 10 （6%） among the continuous suture cases （P = 0.102）. Major pancreatic leakage developed in three interrupted suture patients （2%） and zero continuous suture patients （P = 0.026）. In multivariate analysis, soft pancreatic consistency （odds ratio, 5.5; 95% confidence interval 2.3-13.1） and common bile duct cancer （odds ratio, 3.7; 95%CI 1.6-8.5） were＇predictive of pancreatic leakage.CONCLUSION： Pancreatic texture and pathology are the most important factors in determining the fate of pancreaticojejunal anastomosis and our continuous suture method was performed with significantly decreased occurrence of major pancreatic fistula. In conclusion, the continuous suture method is more feasible and safer in performing duct-to-mucosa pancreaticojejunostomy.

瞄准：学习是由比较发现一种更好起作用的技术的这的目的为胰管空肠吻合术的外部层与连续的针打断了针，即在胰和空肠浆膜肌膜层的树桩实质之间的针，和其它为胰腺的漏的发生冒因素的风险。方法：在到 2004 年 10 月的时期 1997 年 1 月期间， 133 个病人与连续缝术为胰管空肠吻合术和 170 个病人的外部层与间断缝术在 pancreaticoduodenectomy 以后经历了 end-to-side 和 duct-to-mucosa 胰管空肠吻合术重建在我们由一位外科医生的机构。结果：在在诊断，胰的质地， octreotide 的使用和病理学的舞台的二个组之间没有有效差量。胰腺的管在间断缝术盒子之中并且在 10 发生在 14 个病人(11%)(6%) 在连续缝术盒子之中(P = 0.102 ) 。主要的胰腺的漏在三个间断缝术病人(2%) 和零个连续缝术病人发展了(P = 0.026 ) 。在里面多变量分析，软胰腺的一致性(机会比率， 5.5；95% 信心间隔 2.3-13.1 ) 并且胆总管癌症(机会比率， 3.7；95% CI 1.6-8.5 ) 胰腺的漏是预兆的。结论：胰腺的质地和病理是在决定 pancreaticojejunal 吻合和我们的连续缝术方法的命运与主要的胰腺的管的显著地减少的出现被执行的最重要的因素。在结论，连续缝术方法在执行 duct-to-mucosa 胰管空肠吻合术更可行、更安全。