胰管空肠连续吻合联合肠腔外引流预防胰十二指肠切除术后胰瘘

Continuous suture of pancreaticojejunostomy plus extra drainage of the stoma for the prevention of pancreatic leakage after pancreaticoduodenectomy

目的对胰十二指肠切除术的胰肠吻合缝合技术和置管引流方法进行改进，以防止胰瘘的发生。方法对2004年6月至2007年9月138例胰十二指肠切除术患者的胰肠吻合采用降落伞式胰管空肠连续吻合和吻合口下方肠腔减压外引流的临床资料进行回顾性分析。结果降落伞式胰管空肠连续吻合时间平均11min，手术时间明显缩短，全部病例均未出现胰肠吻合口漏，术中出血平均353±61ml，平均住院日19.2d。6例患者出现肺部感染，3例上消化道出血考虑为应激性溃疡，2例患者出现胃排空障碍，均保守治疗痊愈，无手术死亡。结论降落伞式胰管空肠连续吻合和吻合口局部肠腔减压外引流，操作简便、省时、并发症少，是胰肠吻合术的一种有效改进。

Objective To improve the pancreaticoenterostomy technique and drainage in pancreaticoduodenectomy, so as to prevent postoperative pancreatic leakage. Methods One hundred and thirty-eight pancreatieoduodenectomy cases underwent parachute continuous running suture of pancreaticojejunostomy and extra drainage of the anastomotie stoma. Results The average time of the double-deck continuous invaginated pancreaticoenterostomy was 11 minutes, and there was no pancreaticoenterostomy leakage in all cases. Intraoperative blood loss was 353±61ml, the average hospital stay was 19.2days. Pulmonary infection developed in 6 cases, three cases suffered from postoperative upper gastrointestinal bleeding due to stress ulcer, two cases from functional delayed gastric emptying. All these complications were cured by conservative treatment, and there was no mortality in these series. Conclusions The parachute continuous running suture of pancreaticojejunostomy and extra drainage has the advantages of easy performance, saving time and less complications, and is an effective way in the prevention of pancreaticojejunostomy leakage.