摘要
BACKGROUND： Postoperative pancreatic fistula remains the most common complication of pancreaticoduodenectomy （PD） and is potentially lethal. It contributes significantly to prolonged hospitalization and mortality. In this study, we introduced a new technical approach, a modified Roux-en-Y reconstruction and evaluated its safety and feasibility. METHODS： We retrospectively reviewed the patients who had undergone PD with the modified Roux-en-Y reconstructive technique for periampullary malignancies from January 2011 to June 2012. The data on complications, hospital stay and outcomes after the modified Roux-en-Y reconstruction were analyzed. RESULTS： The reconstruction was performed in 171 patients, of whom 92 received pancreaticogastrostomy and 79 received pancreaticojejunostomy. The median duration of surgery was 4.0 hours （range 3.1-6.9） in all patients, and the median blood loss was 530 mL （range 200-2000）. Sixty-nine patients were subjected to transfusions, with a median transfusion volume of 430 mL （range 200-1400）. The median hospital stay of the patients was 14 days （range 11-38）. Their operative mortality was zero and overall morbidity was 18.1% （31 patients）. Only four patients （2.3%） developed pancreatic fistulas （grade A fistulas in two patients and grade B in two patients）; no patients developed grade C fistula. None of the patients developed bile reflux gastritis. CONCLUSIONS： The modified Roux-en-Y reconstruction, which isolates biliary anastomosis from pancreatic, gastric or jejunalanastomosis, is a safe, reliable, and favorable technique. But it needs further investigation in randomized controlled trials.
BACKGROUND： Postoperative pancreatic fistula remains the most common complication of pancreaticoduodenectomy （PD） and is potentially lethal. It contributes significantly to prolonged hospitalization and mortality. In this study, we introduced a new technical approach, a modified Roux-en-Y reconstruction and evaluated its safety and feasibility. METHODS： We retrospectively reviewed the patients who had undergone PD with the modified Roux-en-Y reconstructive technique for periampullary malignancies from January 2011 to June 2012. The data on complications, hospital stay and outcomes after the modified Roux-en-Y reconstruction were analyzed. RESULTS： The reconstruction was performed in 171 patients, of whom 92 received pancreaticogastrostomy and 79 received pancreaticojejunostomy. The median duration of surgery was 4.0 hours （range 3.1-6.9） in all patients, and the median blood loss was 530 mL （range 200-2000）. Sixty-nine patients were subjected to transfusions, with a median transfusion volume of 430 mL （range 200-1400）. The median hospital stay of the patients was 14 days （range 11-38）. Their operative mortality was zero and overall morbidity was 18.1% （31 patients）. Only four patients （2.3%） developed pancreatic fistulas （grade A fistulas in two patients and grade B in two patients）; no patients developed grade C fistula. None of the patients developed bile reflux gastritis. CONCLUSIONS： The modified Roux-en-Y reconstruction, which isolates biliary anastomosis from pancreatic, gastric or jejunalanastomosis, is a safe, reliable, and favorable technique. But it needs further investigation in randomized controlled trials.
基金
supported by grants from the National Natural Science Foundation of China (81272659, 81101621 and 81372353)
