胰管空肠侧侧吻合对胰十二指肠切除术后胰瘘的预防作用观察

Side-to-side pancreaticojejunostomy in prevention of pancreatic fistula after pancreatoduodenectomy

目的在胰十二指肠切除手术过程中行胰管空肠侧侧吻合,并观察其预防术后胰肠吻合口瘘的临床效果。方法2005年6月-2008年3月,对成都军区总医院全军普通外科中心收治的167例胆道或胰头恶性肿瘤患者施行胰十二指肠切除术。167例患者中,术前通过磁共振胰胆管造影术和（或）B超等影像学检查证实胰体部主胰管直径〉10mm者26例,男17例,女9例,平均年龄59.8（41～72）岁,其中胰头癌10例、胆管下段癌4例、十二指肠乳头癌12例,在术中切开胰体部的主胰管后,缝闭残胰断端,将切开的主胰管与空肠侧侧吻合,然后常规行胆管空肠吻合及胃空肠吻合。结果26例患者手术后并发残胃应激性溃疡1例,急性肾功能不全1例,但无一例发生胰肠吻合口瘘,全部患者均康复出院,患者住院11～26d,平均15.6d。结论对于主胰管扩张的患者,在胰十二指肠切除手术中,采用胰管空肠侧侧吻合处理残胰方法简单、疗效可靠,不失为预防胰十二指肠切除术后胰瘘的一种良好方法。

Objective To investigate the feasibility of side-to-side pancreaticojejunostomy during pancreatoduodenectomy to preven postoperative pancreatico-jejunal anastomotic fistula. Methods From June 2005 to March 2008, 167 patients with malignant tumor of bile duct or pancreatic head underwent pancreatoduodenectomy in the hospital the authors served. Of the 167 patients, the diameter of the main pancreatic duct was over 10mm, as affirmed by magnetic resonance cholangiopancreatography （MRCP） or B-ultrasound in 26 cases. The median age of the 26 patients, consisting of 17 males and 9 females, was 59.8 years （ranged from 41 to 72 years）. Of the 26 patients, 10 patients were suffering from carcinoma of pancreatic head, 4 patients were with carcinoma in the lower segments of common bile duct, and 12 patients were with carcinoma of duodenal papilla, and all of them were complicated with dilatation of the main pancreatic duct （over 10mm in diameter）. During pancreatoduodenectomy, the main pancreatic duct was incised, the open pancreatic remnant was sutured, and a side-to-side anastomosis of the incised main pancreatic duct and jejunum was performed, finally routine cholangiojejunostomy and gastro- jejunostomy were carried out. Results After the surgery, one of the 26 patients was complicated by a stress ulcer in the stomach, and another one with acute renal insufficiency. But no single person was complicated by pancreatico-jejunal anastomotic fistula. All patients recovered and discharged, and the hospital days ranged from 11 to 26 days （15. 6 clays in average）. Conclusions This method is simple and reliably effective in management of pancreatic remnant in pancreatoduodenectomy in patients in whom the main pancreatic duct is dilated. It can be used to prevent pancreatic fistula after pancreatoduodenectomy.