胰肠吻合方法改进与应用的临床研究(附38例报告)

Clinical study on the improvement and application of the method of pancreaticojejunostomy(a report of 38 cases)

目的探讨胰十二指肠切除术(pancreaticoduodenectomy,PD)胰空肠吻合的一种新方法在预防术后胰空肠吻合口瘘的应用价值。方法自2009年6月~2013年8月行胰十二指肠切除术38例,胰肠吻合均采用空肠粘膜剥离双荷包缝合套扎+吻合口胰上下缘缝扎法,分析此吻合术式的可行性、疗效及并发症。结果本组38例胰十二指肠切除手术及胰肠吻合无手术死亡。胰漏2例,发生率为5.26%(2/38),其中胰头癌1例,胆管癌1例,分别发生于术后第7天和第10天,每天约20~100 ml,经用生长抑素药物治疗3周后治愈。12~18 d拆线,其他患者恢复良好,未发生腹腔感染、胆瘘、肠瘘及大出血等严重并发症。无死亡病例。结论空肠粘膜剥离双荷包缝合套扎+吻合口胰上下缘缝扎法,在胰肠吻合中可行性强,方法简单,疗效可靠,胰瘘发生率低,有明显的临床优势,有实用推广价值。

Objective To investigate the application value of a new pancreaticojejunostomy method to prevent the postoperative pancreatic fistula of pancreaticoduodenectomy( PD). Methods from June of 2009 to August of 2013, 38 PD patients were treated with pancreaticojejunostomy(pj) which used jejunal mucosal stripping with double purse string suture ligation and anastomotic pancreatic upper and lower edge suture ligation. Retrospective analysis of feasibility, efficacy and complications of the anastomosis. Results 38 cases of patients with PD and PJ were all alive. 2 case of pancreatic leakage, which occurred on the seventh day and the tenth day postoperative, daily drainage fluid volume about 20-100 ml, recovered with the use of somatostatin drug after 3 weeks, including 1 cases of pancreas head carcinoma, 1 cases of cholangiocarcinoma. The other patients recovered well, no abdominal infection and bleeding, no biliary and intestinal fistula, no other serious complications.No death case. Conclusion the PJ of jejunum mucosal stripping double purse string suture ligation and anastomotic pancreatic upper and lower edge suture ligation, which pancreatic fistula rate is low, is feasibility, simple, effective and reliable, have significant clinical benefit and practical value.