改良胰肠吻合及消化道重建方法在胰十二指肠切除术中的应用  

Application of a modified invagination pancreaticojejunostomy and reconstruction of gastrointestinal tract after pancreaticoduodenectomy

作　　者：朱斌[1] 马优钢[1] 张永杰[1] 耿利[1] 范飞[1] 陈科济[1] 

机构地区：[1]第二军医大学附属东方肝胆外科医院胆道二科,上海200438

出　　处：《中华临床医师杂志（电子版）》2012年第9期I0001-I0004,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨胰十二指肠切除术中胰-肠吻合技术及消化道重建方法的改进方式。方法搜集1998年3月至2010年12月采用改良胰空肠套入式吻合及胰腺、胆道Roux-en-Y型吻合重建消化道的132例行胰十二指肠切除术患者的临床资料,回顾分析术后早期并发症及术后6个月的随访资料。术后胰瘘诊断及分级标准参考国际胰瘘研究小组的临床指南。结果 132例患者中,手术死亡1例(0.8%),死因为溶血反应致急性肾功能衰竭;术后发生胰瘘16例(12.1%),A级者12例、B级者2例、C级者2例(需再次手术治疗)。无因胰瘘导致的死亡。112例获随访,随访期间无肿瘤复发者93例,除4例(4.3%)有脂肪痢样慢性腹泻和营养状况较差外,余89例消化吸收功能基本正常,营养状况良好;无胆汁反流性胃炎、胆道逆行感染、胃肠吻合口溃疡的发生。结论该改良胰-肠吻合方法具有操作简便、吻合可靠、胰瘘率低的特点,并能较好地保留胰腺外分泌功能;胰腺、胆道Roux-en-Y型吻合可减少后期并发症的发生。Objective To investigate the technique improvement of （P J） and reconstruction of gastrointestinal tract after pancreaticoduedenectomy （PD）. Methods Between March 1998 and December 2010,132 consecutive patients underwent PD in which a technique of modified invagination PJ and a Roux-en-Y anastomosis in reconstructing the digestive tract were used. Clinical and follow-up data of these patients were reviewed for operative details ,early postoperative events and outcomes at 6 months after the operation. PF was defined by the International Study Group on Pancreatic Fistula （ISGPF） guidelines and graded （ A, B or C ） according to the clinical procedures and outcome. Results In this group of 132 patients,there was only 1 early death（O. 8% ） from acute renal failure and pancreatic fistula was observed in 16 patients（ 12. 1% ）, 12 in grade A ,2 in grade B and 2 in grade C. For the 2 patients in grade C ,PF was surgically managed. There were no early or late deaths attributable to PF. Six months after the operation, all the patients were free of the later complications , like bile reflux gastritis, retrograde infection of biliary tract or gastrointestinal anastomotic ulcer , with the exception in 4, who were found to have steatorrhea. Conclusions The modified invagination PJ is a simple and safe technique. With this technique, the ratio of pancreatic fistula or leakage is relatively low and the function of the pancreatic stump is well reserved . Moreover ,the Roux-en-Y anastomosis in reconstructing the digestive tract is close to the physical and can reduce the incidence of later complications.

关 键 词：胰十二指肠切除术 胰管空肠吻合术 胰腺瘘 吻合术 Roux-en-Y 

分 类 号：R735[医药卫生—肿瘤]