胰断端空肠浆肌鞘内套入吻合术(附11例报告)

Intraseromuscular sheath pancreaticojejunostomy: a new technic ensuring not to produce pancreatic fistula

为了防止胰头十二指肠切除手术后胰肠吻合口瘘的发生,作者设计了一种简易安全的吻合方式,称之为胰断端空肠浆肌鞘内套入吻合术。方法:先游离胰断端3cm;再将空肠端翻转3cm,用电灼或石碳酸破坏其粘膜。接着将两者靠拢,用丝线将胰端与肠粘膜作缝合,注意缝线勿穿透浆肌层,将已翻转且粘膜面已破坏的肠浆肌层翻回原状,使其覆盖胰断端3cm,并将肠断端与胰包膜缝合数针;最后在接近空肠断端两根动脉之间的系膜上穿一根丝线,用以环绕空肠壁结扎,使空肠壁与胰腺紧密相贴,从而液体无法在两层面间流通。经过连续11例临床应用均未发生胰肠吻合口瘘,无腹腔感染,顺利恢复。本法操作简单,安全。具有很高的实用价值。

In order to assuredly prevent pancreatic fistula following pancreaticoduodenectomy, the authours designed a safe but simple and easy technique, named intraseromuscular sheath pancreaticojejunostomy. This procedure is performed as follows. Firstly, the pancreas were cut end is isolated for a distance of 3cm; 3cm of jejunum cut end was turned up and with its mucosa destroyed by electric coagulation or carbolic acid. Secondly, both cut ends were brought together and sutured with silk, intermittently or continuously, being sure not to penetrate the serosa and muscular layer of the jejunum. Then, the turned up jejunum is resumed to its normal position and sutured to the capsule of the pancreas with few stiches for fixation. Lastly, the jejunum is bound to the pancreas with a thread. All 11 cases undergone this technique did well. There were no anastomotic leakage and bleeding. Theoretically and practically, this technique is safe and simple. It is anticipated that this technique might become a standard procedure in the future.