胰十二指肠切除胰腺空肠端侧吻合156例分析

Individualized end-side pancreaticojejunostomy for pancreaticoduodenectomy(156 cases reported)

目的:探讨胰十二指肠切除术中胰腺空肠端侧吻合技术。方法:回顾性分析山东大学齐鲁医院肝胆外科2004年3月—2012年6月156例胰十二指肠切除术行胰腺空肠端侧吻合患者的临床资料。根据胰腺的质地、厚度、胰管直径、胰管后壁胰腺组织的厚度、有无炎症,结合空肠的直径、空肠壁的厚度选择胰管-空肠黏膜-黏膜吻合、端侧套入式吻合等不同的吻合方式。结果:术中胰肠重新吻合8例。术后胰瘘3例、胆瘘2例、死亡2例。结论:胰十二指肠切除术中胰腺空肠吻合应根据患者的胰腺和空肠情况进行个体化选择。

Objective： To analyze the procedure of end-side pancreaticojejunostomy after pancreaticoduodenectomy（PD）. Methods： The clinical data of 156 patients who underwent PD between March, 2004 and June, 2012 were reviewed retrospectively. Individualized end-side pancre- aticojejunostomy was performed according to the pancreas testure, the thickness of pancreas body and posterior wall, the diameter of pancreatic duct and the pancreatitis combined with the diameter of jejunum and the thickness of the jejunum wall. Different kinds of end-side pancreaticojejunostoy contain duct-mucosa pancreaticojejunostomy and invaginated pancreaticojejunostomy. Results： Re-ananstomosis of pancreaticojejunostomy was performed on 8 patients during operation. Pancreas fistula occurred on 3 patients, bile fistula occurred on 2 patients and 2 patients died. Conclu. sion： Individualized end-side pancreaticojejunostomy according to the local condition of the operation was optimal for pancreaticoduodenectomy.