依据胰腺残端形态选择适当胰肠吻合方式的探讨

Selection of appropriate pencreaticojejunostomy approaches based upon morphohistological features of pancreatic stump

目的 从残端胰腺组织形态角度思考目前所采用的胰肠吻合方式存在的风险,探讨依据胰腺组织形态不同选择适当胰肠吻合方式的临床效果.方法 研究为准实验设计,将行胰十二指肠切除术的病例,依据术前影像学资料和术中观察将胰腺组织情况分为三种：胰腺组织呈慢性炎症改变,胰腺萎缩;胰腺组织呈慢性炎症改变,胰腺未出现萎缩;胰腺组织正常.针对这三种情况分别采取相应的胰肠吻合方式,第一种情况行经典胰肠套入式吻合,第二种情况行空肠U形半包入胰肠套入式吻合,第三种情况行空肠完全套入式胰肠吻合.结果 连续行胰十二指肠切除术70例,其中行经典胰肠套入式吻合12例,行空肠U形半包入胰肠套入式吻合34例,行空肠完全套入式胰肠吻合24例;术后发生B级胰瘘1例,发生率为1.4％;死亡1例,病死率为1.4％;总并发症发生率为57.1％.结论 针对不同残端胰腺组织形态情况,选择适当的胰肠吻合方式有助于降低术后临床胰瘘的发生.

Objective In terms of pancreatic histology,the risks of current pencreaticojejunostomy means are considered to explore the clinical efficacies of different pencreaticojejunostomy approaches based upon morphohistological features of pancreatic stump.Methods With a quasi-experimentation desigm it divided the cases of pancreaticoduodenectomy into three kinds based on preoperative imaging profiles and intraoperative findings：chronic inflarnmation of pancreatic tissue with atrophy; chronic inflammation of pancreatic tissue without atrophy; normal pancreas.The relevant pencreaticojejunostomy approaches were implemented：classic pencreaticojejunostomy; typed jejunum semi-closure pencreaticojejunostomy; jejunum complete pencreaticojejunostomy.Results Seventy cases of pancreaticoduodenectomy were performed.And the procedures included classic pencreaticojejunostomy （n =2）,U-typed jejunum semi-closure pencreaticojejunostomy （n =34） and jejunum complete pencreaticojejunostomy （n =24）.The postoperative complications included B-level pancreatic fistula （n =1,1.4％）and mortality （n =1,1.4％）.And the overall incidence was 57.1 ％.Conclusions Based upon morphohistological features of pancreatic stump,appropriate pencreaticojejunostomy approaches may be adopted to reduce the postoperative incidence of pancreatic fistula.