残胰直接套入空肠吻合技术在胰十二指肠切除术中的临床应用研究  

Clinical Study of Direct-covering Pancreaticojejunostomy with Remaining Jejunal Mucosa

作　　者：覃谦[1] 王力斌[1] 李洪[1] 李爱辉[1] 唐世龙[1] 欧阳杰[1] 谢书勤[1] 梁卓虹[1] 

机构地区：[1]中山大学附属东华医院普瘤外科,广东省东莞市523110

出　　处：《中国肿瘤临床》2010年第1期52-55,共4页Chinese Journal of Clinical Oncology

摘　　要：目的:总结和探讨胰十二指肠切除术后空肠非去黏膜化的胰-肠直接套入吻合方法。并观察其术后发生胰瘘及对与该手术方式有关的并发症等资料进行分析。方法:2005年3月至2009年6月中山大学附属东华医院行胰十二指肠切除术21例,残胰游离3.0cm,距离残胰断端2.5～3.0cm行空肠全层与部分胰腺后壁组织间断缝合,将残胰套入空肠2.5～3.0cm,再按后壁缝合方法缝合前壁,在距离残胰断端1cm处用7号丝线环绕空肠将残胰予以捆扎。结果:除1例出现因残胰断端出血再次手术进行缝合止血外,全组患者术后恢复顺利,无1例发生胰瘘或出现其他并发症。结论:胰腺质地和胰-肠吻合方式虽是胰瘘并发症的主要因素,但也与手术者胰-肠吻合操作技巧或熟练程度、围手术期的管理或治疗措施有关。采用残胰直接套入非去空肠黏膜化的胰-肠吻合方法与目前任何其他胰-肠吻合方法比较均较为简单,有待于进一步探讨、总结和研究。Objective： To investigate and summarize the procedures of direct-covering pancreaticojejunostomy with remaining jejunal mucosa in pancreaticoduodenectomy and to analyze the incidence of pancreatic fistula and other postoperative complications. Methods： A total of 21 patients were treated with pancreaticodu- odenectomy between May 2005 and June 2009. During the surgery, we dissected 3cm long remnant of the pancreas out of ambient tissues. Near the 2.0-3.0cm of the pancreatic remnant, we fixed partial posterior wall with the full-thickness jejunum without mucosa destroyed by interrupted suture, and then pushed the remnant into the jejunum and fixed the anterior wail. Finally, at the 1.0cm of the panceratic remnant, we binded the jejunum to surround the pancreas through 7-silk sutures. Results： One case was treated with secondary surgery due to bleeding of the pancreatic remnant. The other patients recovered smoothly without pancreatic fistula or other complications. Conclusion： Postoperative pancreatic fistula is related to the texture of pancreas, method of pancreaticojejunostomy, surgical skills and perioperative treatment. Compared with other types of pancreati- cojejunostomy, direct-covering pancreaticojejunostomy with remaining jejunal mucosa is simpler.

关 键 词：空肠非去黏膜化 胰腺 胰-肠吻合 临床研究 

分 类 号：R735[医药卫生—肿瘤]