CAJ | 학술논문

目的对胰肠直接套入和包盖于残胰腺的空肠端不去黏膜化处理的胰肠吻合方式进行探讨.方法对2005年3月至2009年8月期间行胰腺切除手术的28例病例进行临床分析,其中行胰十二指肠切除术26例,行保留胰头的胰腺切除术2例.术中均采用残胰直接套入空肠吻合方法,即包盖于残胰端的空肠不去黏膜化处理,将残胰直接套入空肠2.0 cm～2.5 cm,将空肠断端与残胰胰腺相应部位间断缝合固定,距离残胰断端1 cm处用7号丝线环绕空肠将残胰予以捆扎.结果 28例患者均未发生胰瘘,1例患者术后因残胰断端出血行二次手术,全部病例术后均顺利恢复出院.结论复杂的胰肠吻合尤其是通过缝合方式除增加手术时间外,更未必能减少甚至增加胰瘘的发生.而采用残胰直接套入空肠与包盖于残胰端的空肠端不去黏膜化处理的胰肠吻合方法,除吻合方法更为简单外,更重要的是保持了包盖于残胰腺的空肠壁完整性,在捆扎线的捆扎作用下可降低或避免胰瘘的发生.
목적 대이장직접투입화포개우잔이선적공장단불거점막화처리적이장문합방식진행탐토.방법 대2005년3월지2009년8월기간행이선절제수술적28례병례진행림상분석,기중행이십이지장절제술26례,행보류이두적이선절제술2례.술중균채용잔이직접투입공장문합방법,즉포개우잔이단적공장불거점막화처리,장잔이직접투입공장2.0 cm～2.5 cm,장공장단단여잔이이선상응부위간단봉합고정,거리잔이단단1 cm처용7호사선배요공장장잔이여이곤찰.결과 28례환자균미발생이루,1례환자술후인잔이단단출혈행이차수술,전부병례술후균순리회복출원.결론 복잡적이장문합우기시통과봉합방식제증가수술시간외,경미필능감소심지증가이루적발생.이채용잔이직접투입공장여포개우잔이단적공장단불거점막화처리적이장문합방법,제문합방법경위간단외,경중요적시보지료포개우잔이선적공장벽완정성,재곤찰선적곤찰작용하가강저혹피면이루적발생.
Objective To investigate the pancreaticoenterostomy technique using end to end anastomosis of remianing pancreas and jejunum with jejunum mucus preserved. Methods 28 cases underwent pancreatectomy were observed and analyzed from May 2005 to August 2009. There were 26 cases underwent duodenopancreatectomy and 2 cases underwent the pancreatectomy of pancreas body and tail. All cases used the end to end pancreaticoenterostomy, remnant pancreas was directly anastomosed with jejunum without destroy of jejunal mucosa. During the operation, 2.0 cm～2.5 cm long remnant of pancreas was pulled into jejunum without mucosa destroyed. Then, the cut end of the jejunum was fixed on the pancreatic remnant correspondingly by interrupted suture. Finally, a 7-silk suture was used to bind the jejunum and the pancreatic remnant together 1 cm away from the cut surface of the pancreatic remnant. Results 1 case underwent operated again due to bleeding of the pancreatic remnant. 28 patients recovered and discharged from hospital without having the complication of pancreatic fistula. Conclusions Because of the complicated suturation methods, the conventional pancreaticoenterostomy consumes more time. But it still has rather high incidence of pancreatic fistula.The new pancreaticoenterostomy which we used can shorten the operating time and integrity and binding stomas. It is effective to lower the incidence of pancreatic fistula.