捆绑式胰肠吻合术100例报告

A report of 100 cases on the binding pancreatlcojejunostomy

目的 探讨捆绑式胰肠吻合术在胰十二指肠切除术后预防胰肠吻合口漏的临床价值。方法 1996年1月～2000年1月间共施行100例捆绑式胰肠吻合术,并与同期94例用传统方法吻合的病例进行对比。捆绑式胰肠吻合手术方法为先将空肠断端向外反摺3cm,将外翻的粘膜用石炭酸破坏3cm;游离胰断端3cm,将其断端与距离空肠断端3cm的空肠粘膜缝合一圈,注意缝针不穿透浆肌层。将反摺的空肠复位后,胰断端就自然进入肠腔之中（长约3cm）,其表面被缺失粘膜的空肠所覆盖,距离断端1cm用可吸收缝线环绕空肠进行捆绑,令空肠与其腔内的胰残端紧密相贴,然后结扎完成手术,术后观察总体恢复情况,B超定期检查残端有无积液等。结果 全组100例,无一例发生胰漏,残端没有积液。结论 捆绑式胰肠吻合术十分安全,能够防止胰肠吻合口漏的发生,且操作简单,不论胰腺质地软硬或胰管有无扩张均可使用,值得进一步推广。

Objective To evaluate the safety and feasibility of a new operative procedure called binding pancreaticojejunostomy (BPJ) for the prevention of pancreatic leakage after pancreatoduo-denectomy (PD). Methods Binding pancreaticojejunostomy was performed in 100 patients from 1996 to 2000. During the operation, the cut end of the jejunum (3 cm) is everted, the everted mucosa of the jejunum is destroyed with carbolic acid. Meanwhile 3 cm long remnant of pancreas is isolated and sutured to the normal mucosa 3 cm away form the jejunum cut end, care being taken not to penetrate the sero-muscular layer. Then, the everted jejunum is restituted to its normal position and the remnant of the pancreas is naturally pushed into the jejunal lumen for 3 cm. Finally, The surface of the pancreatic remnant is closely contact with destroyed jejunal mucosa surface, and a piece of absorbable thread is used to bind circumferentially this jejunum and the pancreatic remnant together, so no gap exits between the jejunal mucosa and pancreatic remnant. Results No pancreatic leakage occurred in the 100 patients With BPJ. Conclusions Binding pancreaticojejunostomy procedure can effectively prevent the occurring of anastomatic leakage and can be applied broadly.