胰胃吻合术治疗胰十二指肠切除术后胰肠吻合口狭窄3例疗效分析

Pancreaticogastrostomy for the treatment of pancreatojejunostomy stricture after pancreaticoduodenectomy:A report of 3 cases

目的观察胰胃吻合术治疗胰十二指肠切除术后胰肠吻合口狭窄的临床疗效。方法回顾性分析2010年5月至2017年12月收治的3例内镜治疗失败的胰十二指肠切除术后胰肠吻合口狭窄病人的临床资料。通过开腹探查、切除胰肠吻合口,采用单层捆绑式胰管胃黏膜吻合术进行残胰消化道重建。观察术中和术后情况。结果从胰肠吻合至诊断胰肠吻合口狭窄的时间分别为72、37和21个月。3例病人手术均顺利完成,手术时间为137、210、120 min,出血量为210、350、180 mL。术后未出现胰瘘、出血、感染等并发症。术后症状缓解,术后随访23、58和15个月未再发作。结论对于内镜治疗失败的胰十二指肠切除术后胰肠吻合口狭窄病人,胰胃吻合术特别是单层捆绑式胰管胃黏膜吻合术是可考虑采取的手术方案。

Objective To investigate the clinical value of pancreaticogastrostomy(PG)in the treatment ofpancreatojejunostomy stricture(PJS)after pancreaticoduodenectomy(PD).Methods The clinical data of 3 patients withPJS who failed the endoscopic treatment underwent PG followed by resection of pancreatojejunostomy(PJ)from May2010 to December 2017 in Department of General Surgery,Xinhua Hospital,Shanghai Jiaotong University School ofMedicine were analyzed retrospectively.After the pancreatointestinal anastomosis was explored and resected,thedigestive tract of the remnant pancreas was reconstructed by using the single-layer bundle pancreaticogastric mucosaanastomosis.The intraoperative and postoperative conditions were observed.Results The median time of presentationwas 72,37 and 21 months.Three cases of operation were completed successfully.The operation time was 137,210,120 min,and blood loss was 210,350,180 m L.No pancreatic fistula,surgical bleeding and other serve complicationoccurred postoperatively.All the 3 patients experienced resolution of symptoms without recurrent acute pancreatitis afterPG during the follow-up of 23,58 and 15 months.Conclusion PG especially duct-to-mucosa PG followed byresection of PJ could be used in the PJS patients who failed the endoscopic treatment.