Hyodo M, Nagai H
Department of Surgery, Jichi Medical School, Tochigi, Japan.
Hepatogastroenterology. 2000 Jul-Aug;47(34):1138-41.
BACKGROUND/AIMS: Pancreatogastrostomy, generally considered to pose less postoperative complications for a small-duct pancreas after pancreatoduodenectomy than pancreatojejunostomy, has usually been conducted with an invagination method, which can cause obstruction of the duct during the follow-up. The purpose of this study was to investigate the short- and long-term results with special reference to the patency of the main pancreatic duct after pancreatogastrostomy performed on a small-duct pancreas, combining an invagination technique with a duct-to-mucosa approximation.
Out of 73 patients with a nondilated pancreatic duct, 24 in an earlier series underwent pancreatogastrostomy only with an invagination. The other 49 in a later period had an additional duct-to-mucosa anastomosis.
Four patients (5.5%) developed a minor anastomotic leak of the pancreas which healed uneventfully within 16-41 days without mortality. Long-term results revealed that the pancreatic duct tended to dilate after pancreatogastrostomy without mucosal adaptation, while the new method of pancreatogastrostomy with duct-to-mucosa anastomosis left the diameter of the pancreatic duct unchanged. Body weight and peripheral blood glycohemoglobin A1c retained preoperative levels, irrespective of the mucosal anastomosis.
Pancreatogastrostomy with mucosa-to-mucosa anastomosis appears to be a useful method of pancreatic reconstruction in both the short- and long-term.
背景/目的：胰胃吻合术通常被认为在胰十二指肠切除术后对小胰管胰腺造成的术后并发症比胰空肠吻合术少，通常采用套入法进行，这可能在随访期间导致导管阻塞。本研究的目的是特别参照对小胰管胰腺进行胰胃吻合术后主胰管的通畅情况，研究短期和长期结果，将套入技术与导管-黏膜对合相结合。
在73例胰管未扩张的患者中，早期系列中的24例仅采用套入法进行胰胃吻合术。后期的另外49例患者进行了额外的导管-黏膜吻合术。
4例患者（5.5%）出现轻微的胰腺吻合口漏，在16 - 41天内顺利愈合，无死亡病例。长期结果显示，胰胃吻合术后在没有黏膜适应的情况下胰管倾向于扩张，而采用导管-黏膜吻合术的新胰胃吻合术方法使胰管直径保持不变。无论黏膜吻合情况如何，体重和外周血糖化血红蛋白A1c均维持在术前水平。
黏膜-黏膜吻合的胰胃吻合术似乎是一种在短期和长期内都有用的胰腺重建方法。
