经肠系膜上血管蒂后间隙置入空肠的改良Child法吻合术(附36例报告)  

PUTTING THE JEJUNUM POSTERIOR TO THE ROOT OF SUPERIOR MESENTERIC VESSELS IN THE WHIPPLE'S PROCEDURE (A REPORT 36 CASES)

作　　者：李森[1] 李春友[1] 杜福田[1] 丁伟[1] 庄冠一[1] 裴永泉[1] 宋钦华[1] 

机构地区：[1]山东潍坊市人民医院肝胆外科,山东潍坊261041

出　　处：《中国现代普通外科进展》2000年第2期51-52,共2页Chinese Journal of Current Advances in General Surgery

摘　　要：目的 探讨消灭胰十二指肠切除后区域性死腔的方法.方法36例胰十二指肠切除后,经肠系膜上血管蒂后间隙置入上提空肠,做改良Child吻合术.结果围手术期因肝衰、上消化道大出血死亡2例,腹腔乳糜瘘、胆瘘各1例均治愈,其余病人均恢复顺利.结论(1)整块切除胰十二指肠的,经肠系膜血管带后间隙上提空肠,可消灭后间隙死腔.(2)在完整切除胰钩突肿瘤时可发挥作用.To explore the method of eliminating the cavity under the root of the superior mesenteric vessels, so that it can decrease the rat of the complication. Methods: We summarized the experience of putting the jejunum under root of the superior mesenteric vessels (SMV) to eliminate the cavity in 36 cases of pancreatoduo-denectomy (PD) during 1996-1999, including the tumour of the pancreas uncinate process involves the SMV in 5 patients, the involved SMV was resected and underwent end-to-end anastomosis. Results: 2 patients died of upper gastrointestinal tract haemorrhage after operation because of hepatic faillure. one patient suffered cisterma chyli fistula and one suffered biliary fistula. Both patients recovered smoothly. 26 patients (76.4%) were followed more than 1 year, and no gastrointestinal disfunction occured. Conclusion: (1)Following the block excision of the pancreatoduodenum, the jejunum is drawn through under the root of SMV, and it is anastomosed to the pancreas and commmon bile duct. So it can eliminate the cavity behind the superior mesenteric vessels'root, and eliminate the liquide probably depositing in the cavity to soak the anastomosis. (2) The jejunum which is drawn though the cavity can support the SMV.

关 键 词：胰十二指肠切除术 胰腺肿瘤 肠系膜上静脉 Child吻合术 肠系膜上血管蒂后间隙置 

分 类 号：R657.51[医药卫生—外科学] R730.56[医药卫生—临床医学]