Okamoto A, Tsuruta K
Department of Surgery, Tokyo Metropolitan Komagome Hospital, Japan.
Surgery. 2000 Apr;127(4):433-8. doi: 10.1067/msy.2000.104488.
A pancreatic leak from the pancreaticojejunostomy after pancreatoduodenectomy has a potential risk of serious complications. We devised a simplified fistulation method for pancreaticojejunostomy.
The fistulation method, which uses a pancreatic drainage tube as a stent without pancreatic duct-to-jejunal mucosa anastomosis, was applied to 162 consecutive patients. They were divided into 3 groups according to the state of the pancreatic remnant: group 1, soft and normal parenchyma (n = 71); group 2, firm and thickened parenchyma (n = 40); group 3, hard and atrophic parenchyma (n = 51). The consistency in relation to the incidence of pancreatic leak and mortality were analyzed. Morphologic changes of the pancreatic remnant in long-term survivors of group 1 were assessed with computed tomography.
A pancreatic leak occurred in 3 patients from group 1, in 2 patients from group 2, and in no patients from group 3 (leak rate, 3%). No operative mortality and 5 hospital deaths (3%) unrelated to a pancreatic leak were observed. The parenchyma of the pancreatic remnant was well preserved in 52% of the long-term survivors and the pancreatic duct was not dilated in 63%.
The fistulation method can be performed safely and easily regardless of the state of the pancreatic remnant, and it provides every surgeon with a low incidence of pancreatic leak among patients.
胰十二指肠切除术后胰肠吻合口胰瘘有发生严重并发症的潜在风险。我们设计了一种简化的胰肠吻合造瘘方法。
将使用胰引流管作为支架且不进行胰管与空肠黏膜吻合的造瘘方法应用于162例连续患者。根据胰腺残端状态将他们分为3组：第1组，胰腺实质柔软且正常（n = 71）；第2组，胰腺实质坚硬且增厚（n = 40）；第3组，胰腺实质坚硬且萎缩（n = 51）。分析胰腺残端状态与胰瘘发生率及死亡率之间的相关性。对第1组长期存活者的胰腺残端进行CT评估其形态学变化。
第1组有3例发生胰瘘，第2组有2例发生胰瘘，第3组无胰瘘发生（胰瘘发生率为3%）。未观察到手术死亡，有5例（3%）与胰瘘无关的住院死亡。52%的长期存活者胰腺残端实质保存良好，63%的患者胰管未扩张。
无论胰腺残端状态如何，该造瘘方法均可安全、简便地实施，且能使患者胰瘘发生率较低。
