摘要
目的探讨捆绑式胰肠端侧吻合的临床疗效。方法回顾性分析2009年3月至2019年12月期间汕头大学医学院附属粤北人民医院肝胆外科实施的70例胰十二指肠切除术行捆绑式端侧胰肠吻合患者的临床资料。其中包括胰头癌16例,十二指肠乳头癌27例,胆管下端癌8例,壶腹部癌2例,胆囊癌侵犯胰头1例,胰腺导管内乳头状黏液瘤6例,肿块型慢性胰腺炎10例,均行胰十二指肠切除术,其中4例胰腺残端明显超过肠腔管径。主要步骤:胰腺断端游离;空肠系膜对侧肠壁切开及荷包缝线预置;胰肠端侧吻合。结果70例患者顺利完成捆绑式胰肠端侧吻合术。术后发生胰瘘3例,其发生率为4.3%(3/70),其中2例未放置空肠袢减压管,1例术后第8天出现胰瘘和胰腺断端出血,再次手术修补或止血后痊愈。发生腹腔出血3例,行开腹止血2例,其中1例术后11 d因急性呼吸窘迫综合征死亡;行血管介入止血1例。发生胃肠吻合口出血和粘连性肠梗阻各1例,再次手术止血或松解粘连后痊愈。发生胆汁漏1例,经保守治疗后痊愈。结论捆绑式胰肠端侧吻合术简单易行、安全、可靠。
Objective To investigate the clinical effect of end-to-side binding pancreaticojejunostomy.Methods From March 2009 to December 2019,70 patients(pancreatic head cancer in 16 cases,duodenal papillary cancer in 27 cases,bile duct cancer in 8 cases,periampullary cancer in 2 cases,gallbladder cancer invading the pancreatic head in 1 case,intraductal papillary myxoma of pancreas in 6 cases,and mass-type chronic pancreatitis in 10 cases)were performed with end-to-side binding pancreaticojejunostomy were retrospectively analyzed,including large pancreas remnant(n=4).The main procedures included isolation of the pancreatic remnant,incising the jejunal wall and preplacing with seromuscular purse string suture around the incision,performing end-to side binding pancreaticojejunostomy.Results The procedures were successful in all 70 patients.Postoperative complications included pancreatic fistula(n=3,4.3%),of three patients cured with reoperation,jejunal loop decompression tube was not placed in 2 patients,and 1 patient had pancreatic fistula and bleeding on the eighth day after operation.One out of 3 patients developing abdominal hemorrhage which reoperation died of acute respiratory distress syndrome,1 patient was cured with the vascular interventional hemostasis.Gastrointestinal anastomotic bleeding(n=1)and adhesive intestinal obstruction(n=1)were cured with reoperation,biliary leakage(n=1)was cured with conservative treatment.Conclusion End-to-side binding pancreaticojejunostomy is simple,safe and reliable.
作者
黄从云
彭淑牖
朱剑华
吴黎明
刘文瑛
谭勇
欧阳再兴
宋灏
HUANG Congyun;PENG Shuyou;ZHU Jianhua;WU Liming;LIU Wenying;TAN Yong;OUYANG Zaixing;SONG Hao(Department of Hepatobiliary Surgery,Yuebei People’s Hospital Affiliated to Shantou University Medical College,Shaoguan,Guangdong 512026,P.R.China;Department of General Surgery,Shaoyifu Hospital Affiliated to Medical College of Zhejiang University,Hangzhou 310016,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2021年第1期95-98,共4页
Chinese Journal of Bases and Clinics In General Surgery
关键词
胰十二指肠切除术
端侧吻合
捆绑式胰肠吻合术
pancreaticoduodenectomy
end to-side anastomosis
binding pancreaticojejunostomy
