捆绑式胰胃吻合术

Binding pancreaticogastrostomy

目的介绍一种新型的胰胃吻合术——捆绑式胰胃吻合术（binding pancreaticogastrostomy，BPG），并探讨其应用价值。方法对2008年5月至10月收治的15例患者行胰十二指肠切除并采用BPG。其中胰头癌7例、十二指肠癌2例、肿块型慢性胰腺炎伴胰管结石1例、壶腹癌1例、胆囊癌1例、胰岛细胞瘤1例、胆总管下端癌2例。BPG的操作包括4个主要步骤：胰腺残端游离；胃后壁切开及荷包缝线预置；胃前壁切开；胰胃吻合（浆肌层捆绑和黏膜捆绑）。结果全组手术均顺利完成，无死亡。并发症包括：并发少量胸腔积液1例，胃排空障碍2例，胆漏2例，均经保守治疗痊愈，全组未出现胰胃吻合口漏。结论应用BPG能够有效地预防吻合口漏的发生，从而显著提高胰十二指肠切除术的安全性。

Objective To discuss the value of a new technique of the binding panereaticogastrostomy（BPG） in panereaticoduodenectomy. Methods From May 2008 to October 2008,15 patients were performed with BPG, included pancreatic head cancer in 7 cases, duodenal adenoearcinoma in 2 cases, mass-type chronic pancreatitis with panereatolithiasis in 1 case, ampullary carciloma in 1 ease, gallbladder cancer in 1 case, islet cell tumor in 1 case and cholangiocarcinoma in 2 cases. The main procedures of BPG included ： isolating remnant pancreas ; slitting partial posterior wall of stomach and preplaced with seromuscular purse-string suture ; cutting gastric anterior wall ; performing pancreatieogastrostomy （binding of outer seromuscular and inner mucous layer of stomach ）. Results The procedures were successful in 15 patients. Postoperative complications included small amount of pleural effusion in 2 cases, delayed gastric emptying in 2 cases and bile leakage in 2 cases. All patients were cured in 2 weeks. No mortality and anstomosis leakage occurred. Conelttsion The application of BPG technique can prevent the anastomosis leakage and improve the safety for pancreaticoduodeneetomy.