胰肠吻合方法的探索

Research on Method of Pancreaticoenterostomy

目的探讨胰肠吻合的新方法,降低胰瘘等并发症发生的概率。方法通过可吸收止血网带及耳脑胶的灵活使用,行改良无缝合的胰管空肠吻合术10例,观察手术完成情况;术后监测血常规、血淀粉酶和脂肪酶以及引流液淀粉酶和脂肪酶水平;术后1个月处死动物观察胰肠吻合口情况并取局部组织行病理学检查。结果 10例动物的手术时间为(35±10)min,其中9例术后恢复顺利并一直存活,腹腔引流液及血淀粉酶和脂肪酶均正常;另1例动物并发胰瘘,于术后第2天开始出现明显腹胀,腹水淀粉酶升高达10 000 u/L,术后第10天死亡,经解剖发现胰管支撑管脱落,胰腺周围感染。结论改良无缝合胰管空肠吻合术与传统胰肠吻合术式对比,同样可以控制胰瘘发生的几率,但手术更简便、实用;该术式有望成为胰腺吻合的常规手术方法之一。

Objective To investigate the new method of pancreaticoenterostomy and decrease the probability of complications like pancreatic fistula etc.Methods By using the absorbable bandage and ear-brain glue,modified sutureless pancreaticoenteromy was made in 10 swines.Experimental data includes： routine analysis of blood,levels of amylase in blood and abdominal drainage and lipase in blood and abdominal drainage.The tissues in anastomosis were taken for pathology examination in 1 month after operation.Results The average operative time was（35±10） min. Nine of ten animals had no pancreatic fistula and survived.The levels of amylase and lipase in abdominal drainage were both normal.One swine had a evident abdominal distensile on 2 days after operation,the level of amylase was 10 000 u/L,then died on 10 days after operation.Pancreatic fistula and infection were found because of the loss of stent in pancreatic duct.Conclusions Comparison with traditional operation,the modified sutureless pancreaticoenteromy can also control the probability of pancreatic fistula.And this method can be hoped to be one of the routine operations of pancreaticoenterostomy because of its simplicity and practicality.