胆胰分流消化道重建在胰十二指肠切除术中的运用

Application of bilio-pancreatic bypass for alimentary reconstruction in pancreaticoduodenectomy

目的 介绍一种新的胆汁胰液分流的消化道重建方式,并探讨其在胰十二指肠切除术中临床应用价值.方法 对136例胰十二指肠切除术采取胆汁胰液分流的消化道重建方式,57例为胰胃吻合,79例为胰肠吻合.手术主要步骤：①胰胃吻合术后,在距胰胃吻合口远端5～ 10 cm处行近端空肠胃后壁端侧吻合.②胰肠吻合术后,胰肠吻合口10 cm左右将胃后壁与空肠行侧侧吻合.随后在距胃肠吻合口40 ～ 50 cm处离断空肠,形成游离肠袢；远端封闭后与胆管行端侧吻合；在距胆肠吻合口40～50 cm处与游离肠袢的远端行侧侧或端侧Y形吻合.收集术前、术中和术后资料分析其临床应用效果.结果 136例消化道重建（含胰胃或胰肠吻合时间）中位时间为71min（62～97 min）,手术死亡率为0；术后并发症为13.2％（18例）,包括术后出血2例,胆漏2例,肺部感染2例,切口脂肪液化并感染2例,胃瘫3例,腹腔感染3例,胰漏4例（3例A级和1例B级胰漏）.结论 胆胰分流的消化道重建方式是一种安全有效的胰十二指肠切除术切除术后消化道重建方式,对降低胰十二指肠切除术后严重并发症发生具有一定的意义.

Objective To introduce a new technique of bilio-pancreatic bypass for alimentary reconstruction and investigate its significance of clinical application in pancreaticoduodenectomy （PD）.Methods A total of 136 patients underwent bilio-pancreatic bypassing for the alimentary reconstruction of PD,including 57 cases of pancreatogastrostomy （PG） and 79 cases of pancreaticojejunostomy （PJ）.The main procedures were listed as followings：①following the PG,the end-to-side anastomosis of jejunum and paries posterior gastricus was operated at 5 ～ 10 cm from the anastomotic stoma; ②following the PJ,the side-to-side anastomosis of jejunum and paries posterior gastricus were operated at 10 cm from the anastomotic stoma.After that,the jejunum were disconnected at 40 ～ 50 cm from the anastomotic stoma.The distant end of free ansa interstinalis was closed and the end-to-side anastomosis of bile duct and intestine was operated; the side-to-side or end-to-side Y type anastomosis of the proximal end of free ansa interstinalis were operated at 40 ～50 cm from the duct jejunum anastomotic stoma.The preoperative,intraoperative and postoperative clinical data were collected to analyze its therapeutic effect.Results The median time for the anastomosis was 71 min（range 62 ～97 min）.The operative mortality was zero and the morbidity was 13.2％ （n =18）,including hemorrhage （n =2）,biliary fistula （n =2）,pulmonary infection （n =2）,adipose liquefaction and infection （n =2）,delayed gastric emptying （n =3）,abdominal infection （n =3） and pancreatic fistula（n =4,3 cases of type A and 1 case of type B）.Conclusion The bilio-pancreatic bypass is a simple,safe and operational reconstruction procedure in PD,which has distinguished signification for reducing postoperative complications