彭氏胰胃吻合术——Ⅰ型与Ⅱ型的比较(兼论Ⅲ型和Ⅳ型)

Peng's pancreaticogastrostomy——Comparative study on types Ⅰ and Ⅱ procedures (with types Ⅲ and Ⅳ appended)

目的:介绍并比较4种类型捆绑式胰胃吻合术(binding pancreaticogastrostomy,BPG),探讨其临床应用价值。方法:2008年5月至2009年5月,共施行Ⅰ型BPG 21例,均行胰十二指肠切除术;施行Ⅱ型BPG 26例,除2例胰腺颈部肿瘤行胰腺中段切除外,其余均行胰十二指肠切除术。这两型在操作中均切开胃前壁或胃残端(该切口可用作胃肠吻合口),将胰腺残端拉入胃腔后进行捆绑吻合。在此期间,同时设计了Ⅲ型BPG和Ⅳ型BPG,两者均避免切开胃前壁或胃残端,在胃后壁处进行胰胃捆绑吻合。结果:全组手术均顺利完成;其中Ⅰ型BPG术后2例出现少量胸腔积液,1例胃排空障碍,2例胆漏;Ⅱ型BPG术后1例出现腹水,2例胃排空障碍,1例腹腔出血;上述病人均经保守治疗而痊愈;2组均未出现胰胃吻合口漏,无死亡病例。结论:BPG具有胆胰分道、胰腺吻合口处于胃液平面以上有利于愈合、无论胰腺残端大小均可实施等诸多特点;4种类型BPG各具优势,但均可有效避免胰漏的发生,显著提高了胰腺手术的安全性。

Objective A comparative study on four types of binding pancreaticogastrostomy（BPG）, especially on types Ⅰ and Ⅱ. Methods From May 2008 to May 2009, type Ⅰ BPG was performed in 21 cases, type Ⅱ in 26 cases. All these cases were carried out with pancreaticoduodenectomy, except for 2 cases with middle segment pancreatectomy （MP）. Both these types needed to excise the gastric anterior wall or to open part of the sealed distal gastric stump, and the incision could be used for gastrojejunostomy or closed if the patient received MP. Types Ⅲ and Ⅳ were designed to avoid this procedure, the binding anastomosis was performed behind the stomach posterior wall directly. Results The procedures were successful in all patients, no mortality nor anastomotic leakage occurred. Postoperative complications included： 2 cases of small amount of pleura1 effusion, 1 case of delayed gastric emptying and 2 cases of bile leakage in type Ⅰ BPG; 1 case of ascites, 2 cases of delayed gastric emptying and 1 case of intra-abdominal bleeding in type Ⅱ BPG; they all cured with conservative treatment. Conclusions BPG has many merits as a new technique： the anastomosis is always placed above the level of the gastric fluid; separate pathways for pancreatic fluid and bile which decreased the hazard of bile leakage; it is suitable for all cases no matter how large is the stump of the pancreas. These four types of BPG have different advantages, they can prevent the incidence of anastomotic leakage effectively.