捆绑式胰肠吻合术第Ⅰ型和第Ⅱ型的对比研究

Compared study on type Ⅰ and Ⅱ binding pancreaticojejunostomy.

目的 对两种类型的捆绑式胰肠吻合术进行对比。方法 同期施行捆绑式胰肠吻合术Ⅰ型 (同时施行空肠粘膜和胰腺缝合以及空肠断端与胰腺缝合等三项防漏步骤 ) 35例 (A组 ) ,与只行捆绑吻合的Ⅱ型手术 49例 (B组 )进行对照观察。结果 两组都没有发生胰肠吻合口漏 ,没有手术死亡。术后随访 ,两组均无胰管扩张或胰腺外分泌功能不足的表现。完成吻合时间A组平均 2 7min ,B组平均 16min。结论 捆绑式胰肠吻合术 ,相比之下Ⅱ型更加简单、省时 ,而且能够在吻合口完成后立即对它进行检测 ,可以避免捆绑过紧 ,从而无须插入胰管导管作为支撑。两种类型的捆绑式胰肠吻合术均可常规用于胰十二指肠切除术 。

Objective Compared study on two types of binding pancreaticojejunostomy.Methods From Jan. 2001 through Jan. 2002,type Ⅰ binding pancreaticojejunostomy was performed for 35 cases(group A),type Ⅱ for 49 cases(group B).Results There was no operative mortality and no anastomotic leakage in both groups. Postoperative gastrointestinal bleed occurred in one case in each group. Stress ulcer in group A healed after conservative treatment, pancreatic stump bleeding point in group B was stoped by reoperation. There was no dilatation of pancreatic duct or pancreatic enzyme deficiency shown during followed-up in both groups. The duration for accomplishing the anastomosis in group A was 27min. averagely, 16min.in group B.Conclusion Type Ⅱ is simpler, time saving and the accomplished anastomosis can be checked up immediately. Therefore the binding would not be too tight,as a result, pancreatic duct stent is unnecessary to be inserted for resisting the pressure from out side. Both type of binding pancreaticojejunostomy can be routinely used in any case with PD. Type Ⅱ is recommended as the first choice.