胰十二指肠切除术后胰肠吻合口狭窄的临床特征及再手术治疗可行性分析  

Clinical feature and feasibility analysis of reconstructive surgery for pancreaticojejunal anastomotic stricture after pancreaticoduodenectomy

作　　者：何俊闯 闫宏宪 田建国 魏思东 刘广波 王维伟 李亚其 张继翔 陈国勇 HE Jun-chuang;YAN Hong-xian;TIAN Jian-guo(Departments of Hepatobiliary Pancreatic Surgery,Henan Provincial People’s Hospital,People’s Hospital of Zhengzhou University,Zhengzhou 450003,China;不详)

机构地区：[1]郑州大学人民医院,河南省人民医院肝胆胰外科,河南郑州450003 [2]郑州大学人民医院,河南省人民医院消化内科,河南郑州450003 [3]郑州大学附属洛阳中心医院肝胆胰腺外科,河南洛阳471099

出　　处：《中国实用外科杂志》2024年第2期205-210,共6页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金项目(No.U2004124);河南省医学科技攻关联合共建(No.LHGJ20200010)。

摘　　要：目的探讨胰十二指肠切除术(PD)后胰肠吻合口狭窄(PJS)的临床表现、危险因素、预防措施及再手术行胰肠吻合重建的可行性。方法回顾分析郑州大学人民医院2015年1月至2020年1月间诊治的6例PD术后PJS病人的临床资料、诊治过程及随访情况。结果6例PD术后病人出现PJS症状的中位时间为19.7(8~60)个月,表现为上腹痛(5/6,83.3%)、腹胀(3/6,50.0%)、脂肪泻(1/6,16.7%)和复发性胰腺炎(1/6,16.7%)。CT及磁共振胰胆管成像(MRCP)主要表现为胰肠吻合口狭窄及远端胰管扩张。5例在研究期间接受了胰肠吻合口重建手术,手术方式包括:胰肠吻合口重新端侧吻合、胰管结石取出+胰管支架植入、胰管-空肠侧侧吻合。中位随访时间为32(23~44)个月,5例重建手术病人术后症状缓解良好,1例保守治疗病人的胰腺炎症状仍反复发作。结论胰管支架植入、可靠的胰肠吻合技术及降低术后胰瘘(POPF)发生率是减少PJS发生的重要因素;胰肠吻合重建手术是安全有效的PJS治疗方式,但应采取个体化的原则。Objective To investigate the clinical manifestations,risk factors,and preventive measures of pancreaticojejunal anastomotic stricture(PJS) after pancreaticoduodenectomy(PD) and the feasibility of reconstructive surgery for pancreaticojejunostomy reconstruction.Methods The clinical data,diagnosis,treatment,and follow-up of 6 patients with PJS from January 2015 to January 2020 in People's Hospital of Zhengzhou University were retrospectively analyzed.Results The median time of symptoms occurrence of PJS was 19.7 months(8-60 months),which included epigastric pain(5/6,83.3%),abdominal distension(3/6,50.0%),steatorrhea(1/6,16.7%) and recurrent pancreatitis(1/6,16.7%).CT and magnetic resonance cholangiopancreatography(MRCP) showed stenosis of pancreaticoenteric anastomosis and distal pancreatic duct dilatation.Five patients underwent pancreaticojejunostomy reconstruction during the study period.The surgical procedures included:End-to-side re-pancreaticojejunostomy,pancreatic duct stone removal and pancreatic duct stent implantation,and side-to-side pancreaticojejunostomy.At a median follow-up of 32 months(23-44 months),5 patients had good symptom relief after reconstructive surgery,and 1 patient had recurrent pancreatitis with conservative management.Conclusion Pancreatic duct stent implantation and reliable pancreaticojejunostomy during PD procedure and reducing the incidence of POPF are important factors in reducing the incidence of PJS.Reconstruction of pancreaticoenteric anastomotic stoma is a safe and effective treatment for PJS,but it should be individualized.

关 键 词：胰十二指肠切除术 胰肠吻合口狭窄 重建手术 

分 类 号：R6[医药卫生—外科学]