可吸收补片加固胰胃吻合术的临床应用

Application of bio-mesh-reinforced pancreatico-gastrostomy after pancreaticoduodenectomy

目的 介绍一种新的可吸收补片加固胰胃吻合方法.方法 回顾性分析浙江大学医学院附属邵逸夫医院2011年5月至2013年1月23例采用可吸收生物补片加固胰胃吻合术患者的临床资料.采用一种可吸收补片加固胰胃吻合术,将可吸收补片“戴戒式”固定于胰腺残端从而加固胰胃吻合口.术中测定胰胃吻合时间及吻合口压力;术后监测腹腔引流液量及引流液淀粉酶值,观察有无术后腹腔感染、出血等并发症发生.结果 23例患者胰胃吻合耗时20～ 35 min,平均24 min.术中吻合口测压25 cm H2O（1 cm H2O =0.098 kPa）时无一例渗漏.根据胰漏分级,术后发生A级胰漏6例（26.1％）,B级1例（4.3％）,C级0例.发生腹腔感染1例,无术后腹腔内出血、胆漏、胃肠吻合口瘘等并发症发生.结论 可吸收补片加固胰胃吻合术作为一种新的吻合方法,操作简单,安全可靠.该方法适用于任何质地的胰腺,特别适用于质地柔软的胰腺行胰腺消化道重建.

Objective To evaluate the clinical efficacy of bio-mesh-reinforced pancreatogastrostomy.Methods A total of 23 patients undergoing bio-mesh-reinforced pancreatogastrostomy from May 2011 to January 2013 were retrospectively analyzed.Their demographic data,operative parameters and post-operative outcomes were recorded.The severity of pancreatic leak was determined according to the criteria of International Study Group on Pancreatic Fistula （ISGPF）.Results The mean anastomotic time was 24 （20-35） minutes.Intra-operative leak tests showed all pancreatic anastomoses were watertight.Six patients （26.1％） had pancreatic leakage of grade A.One patient （4.3％） had pancreatic leakage of grade B.No patient developed postoperative pancreatic leakage of class C.One case of abdominal infection was reported.No severe complications such as hemorrhage,bile leakage or gastrojejunostomy leakage were observed.All patients recovered well within Month 1 post-discharge.Conclusion This novel technique may be a simple and feasible strategy for all types of pancreatic remnants.