CAJ | 학술논문

目的:总结和探讨胰十二指肠切除术后空肠非去黏膜化的胰一肠直接套入吻合方法,并观察其术后发生胰瘘及对与该手术方式有关的并发症等资料进行分析.方法:2005年3月至2009年6月中山大学附属东华医院行胰十二指肠切除术21例,残胰游离3.0cm,距离残胰断端2.5～3.0cm行空肠全层与部分胰腺后壁组织间断缝合,将残胰套入空肠2.5～3.0cm,再按后壁缝合方法缝合前壁,在距离残胰断端1cm处用7号丝线环绕空肠将残胰予以捆扎.结果:除1例出现因残胰断端出血再次手术进行缝合止血外,全组患者术后恢复顺利,无1例发生胰瘘或出现其他并发症.结论:胰腺质地和胰-肠吻合方式虽是胰瘘并发症的主要因素,但也与手术者胰-肠吻合操作技巧或熟练程度、围手术期的管理或治疗措施有关.采用残胰直接套入非去空肠黏膜化的胰-肠吻合方法与目前任何其他胰-肠吻合方法比较均较为简单,有待于进一步探讨、总结和研究.
목적:총결화탐토이십이지장절제술후공장비거점막화적이일장직접투입문합방법,병관찰기술후발생이루급대여해수술방식유관적병발증등자료진행분석.방법:2005년3월지2009년6월중산대학부속동화의원행이십이지장절제술21례,잔이유리3.0cm,거리잔이단단2.5～3.0cm행공장전층여부분이선후벽조직간단봉합,장잔이투입공장2.5～3.0cm,재안후벽봉합방법봉합전벽,재거리잔이단단1cm처용7호사선배요공장장잔이여이곤찰.결과:제1례출현인잔이단단출혈재차수술진행봉합지혈외,전조환자술후회복순리,무1례발생이루혹출현기타병발증.결론:이선질지화이-장문합방식수시이루병발증적주요인소,단야여수술자이-장문합조작기교혹숙련정도、위수술기적관리혹치료조시유관.채용잔이직접투입비거공장점막화적이-장문합방법여목전임하기타이-장문합방법비교균교위간단,유대우진일보탐토、총결화연구.
Objective:To investigate and summarize the procedures of direct-covedng pancreaticojejunostomy with remaining jejunal mucosa in pancreaticoduodenectomy and to analyze the incidence of pancreatic fistula and other postoperative complications.Methods:A total of 21 patients were treated with pancreaticoduodenectomy between May 2005 and June 2009.During the surgery,we dissected 3cm long remnant of the pancreas out of ambient tissues.Near the 2.0-3.0cm of the pancreatic remnant.we fixed partial posterior wall with the full-thickness jejunum without mucosa destroyed by interrupted suture,and then pushed the remnant into the jejunum and fixed the anterior wall.Finally,at the 1.0cm of the panceratic remnant,we binded the iejunum to surround the pancreas through 7-silk sutures.Results:One case was treated with secondary surgery due to bleeding of the pancreatic remnant.The other patients recovered smoothly without pancreatic fistula or other complications.Conclusion:Postoperative pancreatic fistula is related to the texture of pancreas,method of pancreaticojejunostomy,surgical skills and perioperative treatment.Compared with other types of pancreaticojejunostomy,direct-covering pancreaticojejunostomy with remaining jejunal mucosa is simpler.