胰腺-空肠端端套入式间断U型缝合法吻合在胰腺外科中的应用

Effect of end-to-end invagination pancreaticojejunostomy with circle discontinuous U suture in pancreatic surgery

目的:探讨胰腺-空肠端端套入式间断U型缝合法吻合在胰腺外科应用的临床价值。方法:回顾性分析我院自2001年1月到2006年4月间施行的胰头十二指肠切除术83例。比较不同胰肠吻合方法对胰瘘发生的影响。结果:胰瘘总发生率为27%(22/83)。胰肠端端套入式间断U型缝合法吻合术后恢复良好,无胰瘘发生。端端吻合的胰瘘发生率为40%(10/25);端侧吻合的胰瘘发生率为27%(12/44)。比较各种吻合方式,端端套入式间断U型缝合法吻合的胰瘘发生率显著低于端端吻合(P<0.01)和端侧吻合(P<0.05),而端端吻合和端侧吻合之间胰瘘发生率无明显差异(P>0.05)。结论:胰腺-空肠端端套入式间断U型缝合法吻合降低手术所致胰肠吻合口瘘的发生率,效果满意。但因临床例数较少,其安全可靠性、实用合理性还有待进一步观察、证实。

Objective To summarize the ways of pancreaticoenteric anastomose in the pancreatic operation. To study the safety and feasibility of a new operative procedure called end-to-end invagination pancreadcojejunostomy with circle discontinuous U suture used to prevent anastomotics leakage following pancreaticojejunostomy （PJ）. Method Eighty-three patients receiving pancreaficoduodenectomy in our hospital between 2001 January and 2006 April were reviewed. Results The overall incidence of pancreatic leakage was 27%. The leakage rate following end-to-end invagination pancreaticojejunostomy with circle discontinuous U suture was significantly lower than those of end-to-end anastomosis （P〈0,01） and those of end-to-side anastomosis （P〈0.05）, but there was no significant difference between end-to-end anastomosis and end-to-side anastomosis （P〉0.05）. Conclusion The procedure has a definite effect to avoid anastomotics leakage following pancreaticojejunostomy and would be worthy of being recommended. But because the cases were so lack, the procedure would need be approved more in the future.