人工乳头植入式胰-空肠吻合的初步应用(附10例临床应用体会)

摘要

背景与目的:胰腺空肠吻合口是胰十二指肠切除术成败的关键,近年来虽然对胰肠吻合方式不断改进,但是胰瘘的发生率仍然较高.本文介绍一种改良的胰-空肠端侧吻合方法.方法:胰腺残端术中冰冻切片证实切缘无肿瘤残留,游离远端胰腺2.0～2.5 cm,沿主胰管周围0.2～0.3 cm处呈“0”型或“C”型切开胰腺组织,深约0.6～0.8 cm.鱼口状(“V”型)切除主胰管两侧0.8～1.0 cm的残端胰腺组织后,内翻缝闭,使人工乳头呈“一头双肩”状凸出于胰腺残端.经横结肠系膜戳孔作结肠后人工乳头植入式胰-空肠吻合.结果:10例患者胰-空肠吻合时间为15～20 min,手术后检测引流液淀粉酶,无胰瘘、胆瘘及出血等并发症.术后6～9 d拔除引流管,术后平均住院天数为11 d.结论:人工乳头植入式胰-空肠吻合法简单易行,吻合可靠,术后恢复快,是一种新的安全有效的吻合方法.%Background and purpose: Pancreaticojejunostomy is the most important anastomosis in Whipple operations. In the past decades, many surgeons have tried to improve the skill of pancreaticojejunostomy, however, the rate of pancreatic fistula remains high. Here, we introduced a modified method of pancreaticojejunostomy. Methods: After the diagnosis of the negative surgical margin of pancreatic stump by intraoperative frozen section, the distal pancreas was dissected for a length of 2-2.5 cm. In an estimated distance of 0.2-0.3 cm around the main pancreatic duct, the distal pancreas was incised in C-shape or O-shape and to a depth of 0.6 cm. The pancreatic tissue 0.8 cm away from the main pancreatic duct was resected in V-shape. The stump was managed with inverting sutures. The formed artificial-papilla projected from the stump just like 1 head and 2 shoulders. Then postcolonic artificial-papilla implanted pancreaticojejunostomy was performed. Results: It took about 10-15 minutes to perform the anastomosis in these cases respectively. No pancreatic fistula, bile leakage and bleeding occurred postoperatively. The negative pressure drainage tubes were removed 6-9 days after surgery and the median postoperation hospital staying was 11 days. Conclusion: This modified method of artificial-papilla implanted pancreaticojejunostomy is simple and time-saving. It is proved to be safe and efficient in preventing pancreatic fistula.