胰十二指肠切除术后胰胃吻合术的临床观察

Pancreaticogastrostomy after pancreaticoduodenectomy

目的总结胰十二指肠切除术后胰胃吻合术的临床应用经验。方法回顾性分析本院2007年5月至2010年12月间接受胰十二指肠切除术后胰胃吻合术16例患者的临床资料。全组患者接受将胰腺残端套入胃后壁方式吻合,采用术后检测引流液淀粉酶浓度方法诊断是否出现胰瘘。结果 16例患者手术均顺利完成,平均手术时间(361.1±82.4)min,术中平均输血量(702.5±517.8)ml;术后住院时间平均(19.5±10.9)d;术后并发症3例(18.8%),其中胰瘘并腹腔积液、腹腔出血1例,胰腺残端出血1例,切口感染1例。无住院期间因手术死亡病例。结论胰十二指肠切除术时,根据患者的具体情况合理地选择胰胃吻合是可行及安全的。

Objective To study the feasibility, safety and clinical effects ofpancreaticogastrostomy after pancreaticoduodenectomy. Methods A retrospective review was performed for 16 patients who underwent pancreaticogastrostomy after pancreaticoduodenectomy at the First Hospital of Sun Yat-sen University from May 2007 to December 2010. Results All sixteen cases of pancreaticogastrostomy after pancreatico- duodenectomy were performed successfully. The pancreaticogastrostomy was performed by a invagination technique to the posterior gastric wall using interrupted silk sutures. Leaks from the pancreatic anastomosis were detected by measuring amylase in fluid obtained from surgically placed drains. The mean operative time, mean intraoperative blood transfusion and mean length of postoperative hospital stay was （361.1±82.4） min, （702.5±517.8） ml and （19.5±10.9） d, respectively. The overall mortality rate was 18.8% （3/16） of the patients. Conclusions Pancreaticogastrostomy appears to be a feasible and safe alternative to pancreaticojejunostomy for managing the pancreatic remnant.