保留与去空肠黏膜的胰肠套入吻合方式在胰十二指肠切除术中的应用比较

Comparison of the preserving or removing jejunal mucosa pancreatico-jejunal invaginated anastomosis in pancreatoduodenectomy

目的 对胰十二指肠切除术采用保留空肠黏膜与去空肠黏膜胰肠直接套入加捆扎两种不同的吻合方式进行探讨.方法 2003年2月 2012年12月对58例胰十二指肠切除术患者采用胰空肠套入吻合术；其中A组28例采用保留空肠黏膜残胰直接套入空肠3～4 cm,在距离残胰腺断端2～3 cm处将包盖于残胰腺体的空肠段用7-0丝线予以捆扎.B组30例则为去黏膜化,空肠黏膜外翻3 cm并去黏膜化处理并行肠黏膜下肌层与残胰体断端缝合,之后将空肠复位,随后按A组方法将包盖于残胰体的空肠予以捆扎.结果 A、B两组胰-肠吻合时间比较,A组比B组平均缩短（36±0.34） min（P ＜0.001）；A组和B两组术后并发胰瘘分别为0和20.0％；A组和B两组术后迟发性残胰断端出血分别为3.6％和3.3％.结论 在胰十二指肠切除术采用保留空肠黏膜与去空肠黏膜两种不同胰肠吻合方式中,前者不受残胰质地、胰管大小影响和具有操作简便以及可以降低胰瘘发病率的优点.

Objective To evaluated the preserving or removing jejunal mucosa pancreatico-jejunal invaginated anastomosis in pancreaticoduodenectomy.Methods Between February 2003 and December 2012,58 patients underwent pancreaticoduodenectomy using pancreaticojejunal invaginated anastomosis in our department.In group A,28 patients received pancreatico-jejunal invaginated anastomosis using jejunum preserving technique.Briefly,3 to 4 cm remanent pancreas was inserted into jejunum and thc jcjunum was bundled up using No.7 silk thread at 2 to 3 cm distant to the cutting surface of the pancreas.In group B,30 patients received pancreatico-jejunal invaginated anastomosis using jejunum removing technique.Briefly,the jejunum mucosa was everted and the proximal 3 cmlong mucosa was removed.Then the everted jejunum was re-positioned and the ending of the jejunum was interruptedly sutured to the remanent pancreas.Finally,the covered jejunum was tied up as the group A.Results The pancrcatico-jejunal anastomosis time was 36 ±0.34 minutes shorter in group A than group B （P ＜0.001）.The incidence of pancreatic fistula was higher in group B （20.0％） than group A （0％）.In contrast,the incidence of post-operative pancreatic bleeding was compared between the two groups （3.6％ vs 3.3％,P =1.000）.Conclusions Preserving ejunum mucosa pancreatico-jejunal invaginated anastomosis was unaffected by pancreatic texture pancreatic duct size and position.This method takes the advantages of simple operation and reducing the incidence of pancreatic fistula.