一种新型胰腺空肠吻合方法——空肠浆肌层鞘捆扎法

A Novel Method of Pancreaticojejunostomy-invagination into Demucosalized Jejunal End with Binding

目的介绍一种改进的胰腺空肠端端吻合方法。方法首先将空肠断端去粘膜化后形成浆肌层鞘,将胰腺断端和粘膜层进行第一层缝合。打结后将空肠浆肌层鞘套入胰腺断端,将胰腺断端和浆肌层鞘进行第二层缝合,打结前将一根捆扎丝线在第二层缝线中间包绕胰腺套入部,再进行第二层的打结,将空肠浆肌层鞘固定于胰腺上。最后将捆扎丝线打结,使浆肌层鞘和胰腺之间紧密相贴。临床应用3例,均为胰头十二指肠切除术患者。结果胰腺空肠吻合时间分别为5,8,10 min,无胰漏发生。结论空肠浆肌层鞘捆扎法简单易行,能缩短手术时间,初步结果显示无胰漏发生。

Objective To introduce a novel method of pancreaticojejunostomy. Methods A ring of mucosa in length of 1.5cm was removed in the jejunal end to create a session of demucosalized jejunal loop, four stitches were undertaken between the pancreatic stump and the mucosa ending of jejunum to complete the inner layer of anastomosis, then the pancreatic stump was subsequently invaginated into the demucosalized jejunal end after the stitches were tied. The outer layer of the anastomosis were conducted between the pancreas and the seromuscular layer with another four stitches, and a silk tie was placed around the jejunal end between the untied two wings of the four stitches. Four stitches were tied firstly to guarantee the demucosalized loop fixed safely followed by tying of the silk suture to ensure a non-leaking attaching of the demucosalized loop onto the pancreas. There were 3 cases undergone this novel method to conduct the pancreaticojejunostomy during the Whipple＇s procedure for their periampular malignancies. Result It took 5,8, and 10 minutes to perform the anastomosis in 3 cases, respectively, and no pancreatic leakage occurred postoperatively. Conclusion This method of pancreaticojeju- nostomy-invagination into demucosalized jejunal end with binding is simple and timesaving, based upon this pilot study, it might have the potential to prevent the pancreatic leakage.