套入空肠段肠粘膜破坏对胰肠吻合口愈合的影响

A Study on the Process of Fusion of the Pancreatoenterostomy in Pancreatoduodenectomy

目的：从术后胰漏的发生率和组织病理学角度，比较胰套入空肠段粘膜破坏与否对吻合口愈合的影响。方法：①１０只健康杂种犬分为２组，均行胰尾切除空肠单层套入吻合。一组行套入段肠粘膜全层电灼破坏，另一组不破坏肠粘膜。术后取胰肠吻合口标本行组织病理学检查；②统计分析本院１９８９年１月～２０００年５月行胰肠套入吻合病例中，套入段肠粘膜破坏组与不破坏组的胰漏发生率。结果：两组犬吻合口组织病理学检查显示，肠粘膜破坏组套入段肠壁与胰腺包膜愈合佳，而肠粘膜不破坏组套入段肠壁与胰腺包膜愈合不完全。临床分析显示，肠粘膜破坏组胰漏发生率为２．７％，不破坏组为１６．４％，两组差异显著（Ｐ＜０．０５）。结论：胰套入段空肠粘膜破坏，使肠壁失去分泌功能，与胰腺包膜较可靠地愈合，可减少胰漏发生率。

Objective: To study the process of fusion following pancreatointestinal anastomosis through histo-pathological observation and clinical evaluation of the leakage rate. Methods: Ten dogs submitted to one-layer end-to-end pancreatojejunostomy were divived into 2 groups: (a) 5 dogs had the intestinal mucosa cauterized prior to anastomosis; (b) 5 others kept their intestinal mucosa intact prior to anastomosis. Histo-pathological sections of the pancreatojejunostomic anastomosis were performed 3, 5, 7 and 14 days after operation. Rate of the leakage was recorded and analyzed. Results: No leakage was observed in either groups. Histo-pathologically, dense fusion was observed between the seromuscular layer of the jejunum and capsule of pancreas in Group 1. Clinically, the rate of pancreatic leakage was 2.7% in Group 1 and 16.4% in Group 2(P<0.05). Conclusions: Intes- tinal mucosal cauterizing, enhances the healing process of the pancreatojejunal anastomosis.