捆绑式胰肠端侧吻合术

End-to-side binding pancreaticojejunostomy

目的:介绍一种新型胰肠吻合术——捆绑式胰肠端侧吻合术,及其应用价值。方法:分析2009年3月至2011年3月间7例病人,其中5例行胰十二指肠切除,2例行胰腺中段切除,包括胰头癌3例、胰体癌2例、肿块型慢性胰腺炎2例。其中2例胰腺残端明显过大超过肠腔管径,2例行门静脉-肠系膜上静脉或脾静脉部分切除修补。操作包括3个主要步骤:胰腺残端游离,空肠系膜对侧肠壁切开及荷包缝线预置,胰肠端侧吻合(包括胰腺残端拖入空肠、吻合口两端肠壁固定于胰腺上、下缘后腹膜、浆肌层荷包缝线结扎捆绑)。结果:全组手术均顺利完成,无死亡。并发症包括:切口感染1例,切口疝1例,无胆漏和胰肠吻合口漏发生。结论:捆绑式胰肠端侧吻合术能有效地预防吻合口漏发生,特别是胰腺残端过大者,从而提高胰十二指肠切除术和胰腺中段切除术的安全性。

Objective To explore the value of a new surgical technique of end-to-side binding pancreaticojejunostomy in pancreaticoduodenectomy and middle segmental pancreatectomy.Methods From Mar 2009 to Mar 2011,7 patients（pancreatic head cancer in 3 cases,middle pancreatic cancer in 2 cases and mass-type chronic panereatitis in 2 cases） were performed with end-to-side binding pancreaticojejunostomy in pancreaticoduodenectomy（n=5） and middle segmental pancreatectomy（n=2）,including partial resection and repair of the superior mesenteric-portal vein or splenic vein（n=2） and large pancreas remnant（n=2）.The main procedures include isolation of the pancreatic remnant,incising the jejunal wall and preplacing with seromuscular purse-string suture around the incision,performing end-to-side binding pancreaticojejunostomy,pulling the pancreas remnant into the jejunal lumen,the jejunal wall sutured to the the retroperitoneal tissue for fixation and tying the pre-placed purse-string suture.Results The procedures were successful in all 7 patients.Postoperative complications included incision infection in 1,incisional hernia in 1,no biliary leakage and pancreaticojejunal leakage.Conclusions The application of end-to-side binding pancreaticojejunostomy can prevent the anastomotic leakage,especially in case of high discrepancy between a small jejunum and a large pancreatic remnant,and enhance the safety for pancreaticoduodenectomy and middle segmental pancreatectomy.