摘要
背景与目的:胰腺空肠吻合口是胰十二指肠切除术成败的关键,近年来虽然对胰肠吻合方式不断改进,但是胰瘘的发生率仍然较高。本文介绍一种改良的胰-空肠端侧吻合方法。方法:胰腺残端术中冰冻切片证实切缘无肿瘤残留,游离远端胰腺2.0~2.5 cm,沿主胰管周围0.2~0.3 cm处呈"O"型或"C"型切开胰腺组织,深约0.6~0.8 cm。鱼口状("V"型)切除主胰管两侧0.8~1.0 cm的残端胰腺组织后,内翻缝闭,使人工乳头呈"一头双肩"状凸出于胰腺残端。经横结肠系膜戳孔作结肠后人工乳头植入式胰-空肠吻合。结果:10例患者胰-空肠吻合时间为15~20 min,手术后检测引流液淀粉酶,无胰瘘、胆瘘及出血等并发症。术后6~9 d拔除引流管,术后平均住院天数为11 d。结论:人工乳头植入式胰-空肠吻合法简单易行,吻合可靠,术后恢复快,是一种新的安全有效的吻合方法。
Background and purpose:Pancreaticojejunostomy is the most important anastomosis in Whipple operations.In the past decades,many surgeons have tried to improve the skill of pancreaticojejunostomy,however,the rate of pancreatic fistula remains high.Here,we introduced a modified method of pancreaticojejunostomy.Methods:After the diagnosis of the negative surgical margin of pancreatic stump by intraoperative frozen section,the distal pancreas was dissected for a length of 2-2.5 cm.In an estimated distance of 0.2-0.3 cm around the main pancreatic duct,the distal pancreas was incised in C-shape or O-shape and to a depth of 0.6 cm.The pancreatic tissue 0.8 cm away from the main pancreatic duct was resected in V-shape.The stump was managed with inverting sutures.The formed artificial-papilla projected from the stump just like 1 head and 2 shoulders.Then postcolonic artificial-papilla implanted pancreaticojejunostomy was performed.Results:It took about 10-15 minutes to perform the anastomosis in these cases respectively.No pancreatic fistula,bile leakage and bleeding occurred postoperatively.The negative pressure drainage tubes were removed 6-9 days after surgery and the median postoperation hospital staying was 11 days.Conclusion:This modified method of artificial-papilla implanted pancreaticojejunostomy is simple and time-saving.It is proved to be safe and efficient in preventing pancreatic fistula.
出处
《中国癌症杂志》
CAS
CSCD
北大核心
2011年第9期722-724,共3页
China Oncology