改良胰肠吻合术预防胰十二指肠切除术后胰瘘

The clinical application of modified pancreaticojejunostomy in preventing pancreatic leakage after pancreati-oduodenectomy

目的 探讨降低胰十二指肠切除术后胰瘘的方法。方法 对 2 3例胰十二指肠切除术后胰肠重建作如下改进 :妥善的胰管内支撑及胰液内引流 ,严密的胰断面缝合 ,“伞兵式”胰肠端端套入吻合 ,胰肠吻合口周置双套管引流 ,术后持续低负压吸引 ,胃管经胃肠吻合口引入空肠输入袢 ,到达胆肠吻合口下方并行负压吸引等。结果 2 3例患者均未出现胰瘘 ,无围手术期死亡 ,恢复顺利。结论 妥善而精确的胰肠吻合可有效预防胰十二指肠切除术后胰瘘的发生。

Objective To evaluate the procedures of reducing pancreatic leakage after pancreatioduodenectomy.Methods Modified reconstruction of pancreatico-jejunostomy in 23 cases of pancreatioduodenectomy was used,including reliable supporting tube of pancreatic duct with internal trans-anastomotic drainage,rigorous sutures on the cut surface of pancreas,'paratrooper form' pancreatico-jejunal end to end anastomosis.Double canala was located around the anastomotic stoma to drain with negative pressure continuously;gastric tube was located under the choledocho-intestinal anastomosis in proximal intestinal ansiform through gastric intestinal anastomosis to drain with negative pressure.Results No pancreatic leakage and perioperative period mortality was occurred in this series.Conclusion The careful surgery techniques of pancreaticojejunal anastomosis are effective to prevent pancreatic leakage after pancreatio-duodenectomy.