剥离空肠浆肌层的胰肠套叠式端端吻合术174例观察  

Pancreatico-jejunal invaginated anastomosis by removing seromuscular layer of the jejunum in 174 patients

作　　者：尚培中[1] 苗建军[1] 李晓武[1] 贾国洪[1] 李永庆[1] 

机构地区：[1]解放军第二五一医院普通外科,张家口075000

出　　处：《中华普通外科学文献（电子版）》2011年第4期20-22,共3页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的探讨剥离空肠浆肌层的胰肠套叠式端端吻合术应用价值。方法自1985年8月至2008年10月共施行胰十二指肠切除174例,术后游离胰腺残端2.5～3.0cm,将准备与胰腺吻合的空肠袢断端2.0～2.5cm浆肌层剥除,施行胰肠套叠式端端吻合术,最后在距浆肌层游离缘1.0～1.5cm处空肠上下壁各缝一针,固定套入的胰腺残端。吻合口周围喷撒纤维蛋白胶封闭剂。观察患者消化道重建后恢复和并发症发生情况。结果 174例患者中,术后胰漏8例(4.6%),保守治疗愈合,无腹腔感染及大出血等严重并发症。结论施行胰十二指肠切除消化道重建过程中,采用剥离空肠浆肌层的胰肠套叠式端端吻合术,有助于减少胰漏,适用于胰腺残端各种情况的处理,利于患者顺利康复。Objective To investigate the clinical value of pancreatico-jejunal invaginated anastomosis by removing seromuscular layer of the jejunum. Methods After pancreaticoduodenectomy, the pancreatic stump was freed from the surrounding vessels and structures for a length of 2.5-3.0 cm in 174 patients from August 1985 to October 2008. A jejunal loop was prepared for the pancreatieo-jejunal anastomosis by removing the seromuseular layer of the first 2.0-2.5 cm of the bowel where it would be anastomosed. Invagination procedure was then performed for an end to end anastomosis. Pancreatic stump was finally anchored through the wall of the jejunum superiorly and inferiorly, approximately 1.0-1.5 cm from the seromuscular border of the jejunum. Fibrin tissue adhesive was spraied around stomal in panereatojejunostomy. The status of patient＇ s rehabilitation and operative complications were investigated after digestive tract reconstruction. Results Eight cases of pancreatic leakage （4.6%） were observed. All patients were cured by administrated with sandostatin or stilamin. Postoperative serious complications such as abdominal infection or heavy bleeding were not observed. Conclusion Pancreatico-jejunal invaginated anastomosis by removing seromuseular layer of the jejunum in alimentary tract reconstruct after pancreaticoduodenectomy may promote the recovery of patients by preventing potential anastomotic leakage, irrespective of the conditions of the pancreatic stump.

关 键 词：胰十二指肠切除术 胰肠吻合 胰漏 

分 类 号：R656.6[医药卫生—外科学] R657.5[医药卫生—临床医学]