贯穿缝合式胰肠吻合术83例报告
| 作者: |
1陈益君,
1朱学锋,
1朱永胜
1 江苏省泰兴市人民医院 肝胆外科，江苏 泰兴 225400 |
| 通讯: |
朱学锋
Email: ziwofanxing004@163.com |
| DOI: | 10.3978/.10.3978/j.issn.1005-6947.2015.09.002 |
| 基金: | 江苏省卫生厅医学科研招标课题资助, YG201303 |
摘要
目的：探讨贯穿缝合式胰肠吻合术的临床应用价值。
方法：回顾性分析2006年5月—2014年7月83例胰十二指肠切除术患者的临床资料。患者术中采用贯穿缝合式胰肠吻合术行胰肠吻合，即胰腺切面（而非切缘）与空肠壁、胰管与肠黏膜之间吻合。
结果：83例中胰头癌32例，壶腹部周围癌42例，其他疾病9例；根治性胰十二指肠切除81例，非根治性切除2例。手术时间220~350 min，平均290 min；胰肠吻合时间6~22 min，平均8 min。按ISGPF诊断标准，术后具有临床意义的胰瘘8例（9.6%），均为B级单纯性胰瘘；胆汁漏2例；胃排空障碍6例；无吻合口出血、无再手术和手术死亡病例。
结论：采用贯穿缝合式胰肠吻合技术可以有效地防止术后胰肠吻合失败及吻合口出血。
关键词：
胰十二指肠切除术；胰管空肠吻合术；胰腺瘘
方法：回顾性分析2006年5月—2014年7月83例胰十二指肠切除术患者的临床资料。患者术中采用贯穿缝合式胰肠吻合术行胰肠吻合，即胰腺切面（而非切缘）与空肠壁、胰管与肠黏膜之间吻合。
结果：83例中胰头癌32例，壶腹部周围癌42例，其他疾病9例；根治性胰十二指肠切除81例，非根治性切除2例。手术时间220~350 min，平均290 min；胰肠吻合时间6~22 min，平均8 min。按ISGPF诊断标准，术后具有临床意义的胰瘘8例（9.6%），均为B级单纯性胰瘘；胆汁漏2例；胃排空障碍6例；无吻合口出血、无再手术和手术死亡病例。
结论：采用贯穿缝合式胰肠吻合技术可以有效地防止术后胰肠吻合失败及吻合口出血。
Penetrating-suture pancreaticojejunostomy: a report of 83 cases
CorrespondingAuthor:ZHU Xuefeng Email: ziwofanxing004@163.com
Abstract
Objective: To investigate the clinical value of penetrating-suture pancreaticojejunostomy.
Methods: The clinical data of 83 patients undergoing pancreaticoduodenectomy (PD) from May 2006 to July 2014 were retrospectively analyzed. All patients received penetrating-suture pancreaticojejunostomy for pancreatic-enteric anastomosis during surgery, which was characterized by anastomosis of the cutting surface (not the cutting margin) of the pancreas to the jejunal wall, and anastomosis of the pancreatic duct to the intestinal mucosa.
Results: Of 83 patients, 32 cases were carcinoma of the pancreatic head, 42 cases were periampullary carcinoma and 9 cases had other conditions; 81 cases underwent radical pancreaticoduodenal resection and two cases had non-radical resection. The operative time was 220 to 350 min, with an average of 290 min, and the time for pancreatic-enteric anastomosis was 6 to 22 min, with an average of 8 min. According to ISGPF criteria, clinically significant postoperative pancreatic fistula occurred in 8 cases, and all were grade B simple pancreatic fistulas. Bile leakage occurred in 2 cases and delayed gastric emptying occurred in 6 cases. No reoperation was needed and no anastomotic bleeding or surgical death occurred.
Conclusion: The technique of penetrating-suture pancreaticojejunostomy can effectively prevent postoperative anastomotic failure at the pancreatic-enteric anastomosis and anastomotic bleeding.
Keywords：
Methods: The clinical data of 83 patients undergoing pancreaticoduodenectomy (PD) from May 2006 to July 2014 were retrospectively analyzed. All patients received penetrating-suture pancreaticojejunostomy for pancreatic-enteric anastomosis during surgery, which was characterized by anastomosis of the cutting surface (not the cutting margin) of the pancreas to the jejunal wall, and anastomosis of the pancreatic duct to the intestinal mucosa.
Results: Of 83 patients, 32 cases were carcinoma of the pancreatic head, 42 cases were periampullary carcinoma and 9 cases had other conditions; 81 cases underwent radical pancreaticoduodenal resection and two cases had non-radical resection. The operative time was 220 to 350 min, with an average of 290 min, and the time for pancreatic-enteric anastomosis was 6 to 22 min, with an average of 8 min. According to ISGPF criteria, clinically significant postoperative pancreatic fistula occurred in 8 cases, and all were grade B simple pancreatic fistulas. Bile leakage occurred in 2 cases and delayed gastric emptying occurred in 6 cases. No reoperation was needed and no anastomotic bleeding or surgical death occurred.
Conclusion: The technique of penetrating-suture pancreaticojejunostomy can effectively prevent postoperative anastomotic failure at the pancreatic-enteric anastomosis and anastomotic bleeding.