捆绑式胰肠端侧吻合术70例临床应用  

Clinical application of end-to-side binding pancreaticojejunostomy: report of 70 cases

作　　者：黄从云 彭淑牖[2] 朱剑华 吴黎明 刘文瑛 谭勇 欧阳再兴 宋灏 HUANG Congyun;PENG Shuyou;ZHU Jianhua;WU Liming;LIU Wenying;TAN Yong;OUYANG Zaixing;SONG Hao(Department of Hepatobiliary Surgery,Yuebei People’s Hospital Affiliated to Shantou University Medical College,Shaoguan,Guangdong 512026,P.R.China;Department of General Surgery,Shaoyifu Hospital Affiliated to Medical College of Zhejiang University,Hangzhou 310016,P.R.China)

机构地区：[1]汕头大学医学院附属粤北人民医院肝胆外科,广东韶关512026 [2]浙江大学医学院附属邵逸夫医院普外科,杭州310016

出　　处：《中国普外基础与临床杂志》2021年第1期95-98,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨捆绑式胰肠端侧吻合的临床疗效。方法回顾性分析2009年3月至2019年12月期间汕头大学医学院附属粤北人民医院肝胆外科实施的70例胰十二指肠切除术行捆绑式端侧胰肠吻合患者的临床资料。其中包括胰头癌16例,十二指肠乳头癌27例,胆管下端癌8例,壶腹部癌2例,胆囊癌侵犯胰头1例,胰腺导管内乳头状黏液瘤6例,肿块型慢性胰腺炎10例,均行胰十二指肠切除术,其中4例胰腺残端明显超过肠腔管径。主要步骤:胰腺断端游离;空肠系膜对侧肠壁切开及荷包缝线预置;胰肠端侧吻合。结果70例患者顺利完成捆绑式胰肠端侧吻合术。术后发生胰瘘3例,其发生率为4.3%(3/70),其中2例未放置空肠袢减压管,1例术后第8天出现胰瘘和胰腺断端出血,再次手术修补或止血后痊愈。发生腹腔出血3例,行开腹止血2例,其中1例术后11 d因急性呼吸窘迫综合征死亡;行血管介入止血1例。发生胃肠吻合口出血和粘连性肠梗阻各1例,再次手术止血或松解粘连后痊愈。发生胆汁漏1例,经保守治疗后痊愈。结论捆绑式胰肠端侧吻合术简单易行、安全、可靠。Objective To investigate the clinical effect of end-to-side binding pancreaticojejunostomy.Methods From March 2009 to December 2019,70 patients(pancreatic head cancer in 16 cases,duodenal papillary cancer in 27 cases,bile duct cancer in 8 cases,periampullary cancer in 2 cases,gallbladder cancer invading the pancreatic head in 1 case,intraductal papillary myxoma of pancreas in 6 cases,and mass-type chronic pancreatitis in 10 cases)were performed with end-to-side binding pancreaticojejunostomy were retrospectively analyzed,including large pancreas remnant(n=4).The main procedures included isolation of the pancreatic remnant,incising the jejunal wall and preplacing with seromuscular purse string suture around the incision,performing end-to side binding pancreaticojejunostomy.Results The procedures were successful in all 70 patients.Postoperative complications included pancreatic fistula(n=3,4.3%),of three patients cured with reoperation,jejunal loop decompression tube was not placed in 2 patients,and 1 patient had pancreatic fistula and bleeding on the eighth day after operation.One out of 3 patients developing abdominal hemorrhage which reoperation died of acute respiratory distress syndrome,1 patient was cured with the vascular interventional hemostasis.Gastrointestinal anastomotic bleeding(n=1)and adhesive intestinal obstruction(n=1)were cured with reoperation,biliary leakage(n=1)was cured with conservative treatment.Conclusion End-to-side binding pancreaticojejunostomy is simple,safe and reliable.

关 键 词：胰十二指肠切除术 端侧吻合 捆绑式胰肠吻合术 

分 类 号：R657.5[医药卫生—外科学] R656.64[医药卫生—临床医学]