残端封闭型内置管嵌入式胰-空肠吻合法在胰十二指肠切除术中的应用(附21例分析)

A modified method of pancreaticojejunostomy using stamp-closed stent in pancreaticoduodenectomy:an analysis of 21 cases

目的介绍一种改良的胰空肠端侧吻合方法,即残端封闭型内置管嵌入式胰-空肠吻合术。方法胰腺残端修剪成鱼口状("V"型),显露0.2～0.3 cm胰管后内置相应支架管,内翻缝闭胰腺断端。游离空肠,在距闭合端4～6 cm的肠壁对系膜缘切开浆膜,潜行分离后间断缝合肠壁的浆肌层与胰腺后唇。于胰管开口相对应的肠壁上戳孔,直径为0.2～0.3 cm,将内支架管经戳孔处送入肠腔,胰管周围0.3～0.5 cm的胰腺组织与戳孔的肠壁作全层吻合4～8针。剥离的肠壁浆肌层后缘继与残端胰腺后唇缝合。胰空肠吻合口呈线状,完全被肠壁浆肌层覆盖。结果 21例患者的中位胰-空肠吻合时间为15 min,均未发生吻合口瘘及出血等并发症。结论残端封闭型内置管嵌入式胰肠吻合法简单易行,能缩短手术时间,初步结果显示安全。

Objective To introduce a modified method of pancreaticojejunostomy using stent with closed stump.Methods A longitudinal of serosa（3-4 cm in length） was removed in the jejunal end to create a session of deserosalized jejunal,in which a amplitude of mucosa was further removed.Eight stitches were undertaken between the pancreatic stump around pancreatic duct（1 cm in length） and the mucosa ending of jejunum,so as to complete the inner layer of anastomosis.Then another layer of the anastomosis was conducted between the pancreas and the sero-muscular layer of jejunum.The outer layer was formed between the jejunal end and the capsule of pancreas.A total of 21 patients received pancreatieojejunostomy during the Whipple＇s procedure for their periampular malignancies using this method.Results The average time was 15 min for the anastomosis in the 21 patients,and there was no pancreatic leakage postoperatively.Conclusion This modified method of pancreaticojejunostomy using stamp-closed stent is easy to perform and time saving,and it is also safe as showed by this pilot study.