Ⅱ型捆绑式胰胃吻合术的临床疗效  

A pancreas suture-less type Ⅱ binding pancreaticogastrostomy

作　　者：彭淑牖[1] 洪德飞[1] 刘颖斌[2] 李江涛[3] 陶峰[4] 谭志健[5] 

机构地区：[1]浙江大学医学院附属邵逸夫医院普外科,杭州310016 [2]上海交通大学附属新华医院普外科 [3]浙江大学医学院附属二院普外科 [4]绍兴文理学院附属绍兴市人民医院普外科 [5]广东省中医院普外科

出　　处：《中华外科杂志》2009年第23期1764-1766,共3页Chinese Journal of Surgery

摘　　要：目的介绍一种胰腺无针眼吻合技术——Ⅱ型捆绑式胰胃吻合术（BPG），并探讨其临床应用价值。方法2008年11月至2009年5月，在对26例患者行胰腺中段切除或胰十二指肠切除时，应用在Ⅰ型BPG的经验基础上设计的Ⅱ型BPG进行消化道重建。其中胰头癌13例、十二指肠癌3例、壶腹癌2例、胆总管下端癌4例、胆总管下端重度不典型增生1例、胃癌1例、胰腺颈部低度恶性神经内分泌肿瘤1例、胰腺颈部浆液性囊腺瘤1例。Ⅱ型BPG主要操作步骤：胰腺残端游离2—3cm；胃后壁局部切除浆肌层并预置浆肌层荷包缝线；胃前壁或胃远端切开并对胃腔进行消毒；胃后壁去除浆肌层的黏膜层切开并预置黏膜层荷包缝线；游离胰腺残端拉入胃腔并结扎浆肌层、黏膜层荷包缝线。结果全组顺利完成手术，无死亡病例。手术时间3～5．5h，平均（4．0±0．9）h；术后住院时间6～48d，平均（17．8±9．7）d。术后并发症包括胃排空障碍2例、腹腔内出血1例、腹水1例，均经保守治疗治愈。胰头癌术后3个月肝转移2例。结论应用Ⅱ型BPG不仅能有效防止吻合口瘘的发生，而且操作简单、技术要求低，易于临床推广应用。Objective To explore the feasibility and safety of type Ⅱ binding pancreaticogastrostomy （BPG） in pancreaticoduodenectomy and mid-segmentectomy of pancreas. Methods From November 2008 to May 2009,26 patients underwent pancreaticoduodenectomy and mid-segmentectomy of pancreas with typeⅡ BPG reconstruction,including 13 cases of pancreatic head cancer,3 cases of duodenal adenocareinoma, 2 cases of ampallary carcinoma, 4 cases of cholangiocarcinoma, 1 case of bile duct cell severe atypical hyperplasia, and 1 case of stomach cancer. The process of type Ⅱ BPG was described as the following ： after pancreas remnant was mobilized for 2-3 cm, a piece of sero-muscular layer at the posterior gastric wall was excised and then a sero-muscular depth purse-suturing with 3-0 prolene was pre-placed （outer purse-string）. Incising anterior gastric wall or opening part of the closed distal gastric stump, the mucosa layer at the seromuscular defect was incised and then purse-suture at the mucosal tube was pre-placed （ inner purse-string）. Through the two pre-placed purse-strings, the pancreas remnant was pulled into the gastric lumen and then posterior gastric wall was pushed backward to keep it closely in contact with the retro-peritoneal wall. Thereafter, the outer purse-string was tied （outer binding）and then the inner purse-string was tied （inner binding）. Results All cases underwent BPG of type Ⅱ. The operative time ranged from 3 to 5.5 hours. The postoperative hospital stay ranged from 6 to 48 days. Postoperative complications included 1 case of ascites, 2 cases of delayed gastric emptying and 1 case of intra-abdominal bleeding. All cases with complications were cured after nonsurgical treatment. No mortality or pancreatic leakage occurred. Conclusions Panereaticogastrostomy is good for accommodating a large pancreas stump. Binding technique is very helpful in minimizing the leak rate of pancreaticogastrostomy. While type Ⅰ BPG is safe and easy to perform, type Ⅱ is even safer and easier to be

关 键 词：胰十二指肠切除术 吻合术 外科 捆绑式胰胃吻合术 

分 类 号：R656[医药卫生—外科学]