单层连续缝合法行胰肠套入式端侧吻合在胰十二指肠切除术中的应用

Clinical application of monolayer continuous suture in the end-to-side invaginated pancreaticojejunostomy during pancreatoduodenectomy

目的探讨胰十二指肠切除术中采用单层连续缝合法行胰肠套入式端侧吻合对预防胰瘘发生的价值。方法回顾性研究对象为2008年1月至2011年12月在郑州大学第一附属医院肝胆胰外科行胰十二指肠切除术的32例患者。男性19例，女性13例，平均年龄58岁。所有患者均签署知情同意书，符合医学伦理学规定。胰十二指肠切除术中首先切断胰腺，寻找主胰管，准备空肠，胰腺空肠吻合，采用4．0Prolene线单层连续缝合法行胰肠套入式端侧吻合。记录胰肠吻合时间，胰瘘、胆瘘等并发症和死亡发生情况。结果32例患者均顺利完成手术，胰肠吻合时间8-18min，平均12min。无发生胰腺残端及空肠袢出血、手术相关死亡及胰瘘。1例患者出现胆瘘，经保守治疗后痊愈。术后平均住院日15d。结论胰十二指肠切除术中采用单层连续缝合法行端侧套入式胰肠吻合能降低胰瘘发生率，是胰十二指肠切除术的一种有效改进。

Objective To investigate the effect of monolayer continuous suture in end-to-side invaginated pancreaticojejunostomy for preventing postoperative pancreatic fistula during pancreatoduodenectomy. Methods All clinical data of 32 patients in the First Affiliated Hospital of Zhengzhou University from January 2008 to December 2011, including 19 males and 13 females with an average age of 58 years were collected for retrospective analysis. All patients underwent pancreatoduodenectomy. The main pancreatic duct was found after pancreas resection, and was anastomosed with jejunum by end-to-side invaginated pancreaticojejunostomy using monolayer continuous suture with 4-0 prolene stitch thread. This study was approved by local ethical committee and the informed consent of all participating subjects was obtained. The operating time of pancreaticojejunostomy and postoperative complications including pancreatic fistula and biliary fistula were observed. Results All the 32 patients underwent monolayer continuous pancreaticojejunostomy successfully with the average time of 12 minutes （8-18 minutes）. No pancreatic nubs and intestinal loop bleeding occurred in all patients. There was neither postoperative pancreatic fistula nor death case. One patient developed biliary fistula and recovered by conservative treatment. The average length of postoperative hospital stay was 15 days. Conclusions The monolayer continuous suture in the end-to-side invaginated pancreaticojejunostomy during pancreatoduodenectomy is effective in reducing the morbility of pancreatic fistula. It is an improvement of pancreatoduodenectomy.