胰腺组织形态与胰肠吻合方式选择的探讨  

Discussion on pancreatic morphology and pancreaticojejunostomy technique selection

作　　者：耿诚[1] 王喜艳 孟意程 冉东辉 娄子彦 陈启龙[1] 宴冬 徐新建[1] Geng Cheng;Wang Xiyan;Meng Yicheng;Ran Donghui;Lou Ziyan;Chen Qilong;Yan Dong;Xu Xinjian(Department of General Surgery,First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院胰腺外科,乌鲁木齐830054 [2]新疆肿瘤医院肝胆胰外科

出　　处：《中华胰腺病杂志》2018年第4期243-246,共4页Chinese Journal of Pancreatology

摘　　要：目的从残端胰腺组织形态角度思考目前所采用的胰肠吻合方式存在的风险,探讨依据胰腺组织形态不同选择适当胰肠吻合方式的临床效果。方法采用前瞻性队列研究方法。依据术前影像学资料和术中触诊将残端胰腺组织形态分为4型:Ⅰ型为胰腺质硬、萎缩,胰管明显扩张,直径>5 mm,残端胰腺断面长度<3 cm;Ⅱ型为胰腺质硬、萎缩,胰管轻度扩张,直径3~5 mm,残端胰腺断面长度<3 cm;Ⅲ型为胰腺质稍硬、未萎缩,胰管正常或轻度扩张,直径3~5 mm,残端胰腺断面长度≥3 cm;Ⅳ型为胰腺质软、形态正常,胰管不扩张。结果2008年1月至2017年8月连续行胰十二指肠切除术(PD)116例,其中Ⅰ型残端胰腺10例,行经典胰管空肠黏膜对黏膜吻合;Ⅱ型残端胰腺19例,行经典胰肠套入式吻合;Ⅲ型残端胰腺45例,行空肠U型半包入胰肠套入式吻合;Ⅳ型残端胰腺42例,行空肠全套入胰肠套入式吻合。术后发生胰瘘6例,发生率为5.2%,其中1例死亡;出血10例,发生率为8.6%;胃瘫22例,发生率为19.0%,总并发症发生率为33.6%。结论将残端胰腺组织形态依据术前影像学征象及术中触诊分型,根据不同类型选择合理的吻合方式,具有吻合理论更合理和潜在的胰腺组织学风险更低等优势。ObjectiveThe risk of current pancreaticojejunostomy is carefully considered from the perspective of the morphology of remnant pancreas,and we aimed to discuss the clinical outcomes of selecting different pancreaticojejunostomy techniques based on pancreatic morphology.Methods This was a prospective cohort study.The histopathology of remnant pancreatic tissues was categorized into four types based on preoperative radiological images and intraoperative palpation: Type Ⅰ: pancreas with hard texture in palpation,pancreatic atrophy,dilated pancreatic duct larger than 5 mm and remnant pancreatic surface <3 cm;Type Ⅱ: pancreas with hard texture in palpation,pancreatic atrophy and mild dilatation of pancreatic duct with the diameter of 3-5 mm and remnant pancreatic surface <3 cm;Type Ⅲ: pancreas with slightly hard texture,no atrophy,and normal or slightly dilated pancreatic duct with the diameter of 3-5 mm and remnant pancreatic surface ≥3 cm;Type Ⅳ: pancreas with soft texture,normal morphology and pancreatic duct.Results From January 2008 to August 2017,116 consecutive patients underwent pancreaticoduodenectomy in our center.Among them,10 patients with type Ⅰ underwent classic pancreatic ductal mucosa to mucosa anastomosis.19 patients with type Ⅱ underwent classic end to end invaginated pancreaticojejunostomy.45 patients with type Ⅲ underwent classic end to end invaginated pancreaticojejunostomy with overlapping U sutures;42 patients with type Ⅵ underwent total invaginated pancreaticojejunostomy.The post-operative pancreatic fistula occurred in 6 patients (5.2%) with one patient died.Postoperative bleeding occurred in 10 patients (8.6%),and gastroparesis occurred in 22 patients (19.0%).Overall complication rate was 33.6%.Conclusions Classification of pancreatic morphology based on preoperative radiological images and intraoperative palpation and the selection of corresponding pancreaticojejunostomy technique is theoretically rational and has the advantage of potentially reducing the risk of remnant pan

关 键 词：胰腺 胰管空肠吻合术 胰腺瘘 组织学类型 

分 类 号：R657.5[医药卫生—外科学]