CAJ | 학술논문

目的：探讨胰十二指肠切除术（ pancreaticoduodenectomy ，PD）胰肠吻合的一种新方法，以及预防术后胰空肠吻合口瘘的应用价值。方法自2009年6月～2013年8月共收治胰十二指肠切除术患者38例，胰肠吻合均采用空肠粘膜剥离双荷包缝合套扎＋吻合口胰上下缘缝扎法，回顾性分析此吻合术式的可行性、疗效及并发症。结果本组38例患者手术及胰肠吻合（采用“空肠粘膜剥离双荷包缝合套扎法”），均取得成功，胰漏2例，发生率为5．26％（2/38），其中胰头癌1例，胆管癌1例，分别发生于术后第7和第10天，每日引流液量少，约20～100 mL，经用生长抑素（善得定或施他宁等）药物3周后治愈。12～18天拆线，其他患者恢复良好，未发生腹腔感染、胆瘘、肠瘘及大出血等严重并发症。无死亡病例。结论空肠粘膜剥离双荷包缝合套扎＋吻合口胰上下缘缝扎法，在胰肠吻合中可行性强，方法简单，疗效可靠，胰瘘发生率低，有明显的临床优势。
목적：탐토이십이지장절제술（ pancreaticoduodenectomy ，PD）이장문합적일충신방법，이급예방술후이공장문합구루적응용개치。방법자2009년6월～2013년8월공수치이십이지장절제술환자38례，이장문합균채용공장점막박리쌍하포봉합투찰＋문합구이상하연봉찰법，회고성분석차문합술식적가행성、료효급병발증。결과본조38례환자수술급이장문합（채용“공장점막박리쌍하포봉합투찰법”），균취득성공，이루2례，발생솔위5．26％（2/38），기중이두암1례，담관암1례，분별발생우술후제7화제10천，매일인류액량소，약20～100 mL，경용생장억소（선득정혹시타저등）약물3주후치유。12～18천탁선，기타환자회복량호，미발생복강감염、담루、장루급대출혈등엄중병발증。무사망병례。결론공장점막박리쌍하포봉합투찰＋문합구이상하연봉찰법，재이장문합중가행성강，방법간단，료효가고，이루발생솔저，유명현적림상우세。
Objective Toinvestigatethe pancreaticoduodenectomy ( pancreaticoduodenectomy , PD) is a new method ofpancreaticojejunostomy , application value and the prevention ofpostoperative pancreatic fistula .Methods From 2009 June-2013 year in August we treated 38 patients with pancreatoduodenectomy , pancreaticojejunostomywith jejunal muco-sal stripping double purse string suture ligation +anastomotic pancreatic upper and lower edge suture ligation ,retrospec-tive analysis of feasibility , efficacy and complications ofthe anastomosis .Results 38 cases of patients with operation andpancreaticojejunostomy ( the“jejunum mucosal stripping double purse string suture ligation method”) , were success-ful, 2 case of pancreatic leakage , the incidence rate was 5.26%(2/38),including 1 cases of carcinoma of head of pan-creas, 1 cases of cholangiocarcinoma , which occurred on the seventh postoperativeday and the tenth day daily , drainage fluidvolume, about 20~100 mL, the use of,somatostatin (octreotide or somatostatin etc.) drug recovered after 3 weeks. 12~18 D clearing , the other patients recovered well , no abdominal infection , biliary fistula , intestinal fistula and bleed-ing and other serious complications .No death case.Conclusions The jejunum mucosal stripping double purse string su-ture ligation+anastomotic pancreatic upper and lower edge suture ligation , inpancreaticojejunostomy in strong feasibility , method is simple ,effective and reliable , pancreatic fistula rate is low , havesignificant clinical benefit .