Kubyshkin V A, Vishnevskiĭ V A, Danilov M V, Buriev I M, Vukolov A V
Khirurgiia (Mosk). 2001(1):46-50.
The nearest outcomes of 305 pancreatoduodenal resections (PDR) for malignant and benign diseases of the pancreas head and periampullar zone are presented. Necessity of differential approach to choice of method of pancreatodigestive anastomosis formation is demonstrated. In unectatic main duct of the pancreas and unchanged pancreatic parenchyma there is a high risk of postoperative pancreatitis and lethal outcome which achieved 29.8% in the group of 57 patients. In patients with diameter of main pancreatic duct more than 3 mm and fibrotic changes of its parenchyma, the majority of methods of pancreas inclusion the in digestive canal were characterized by favorable results, lethality was 7.7% among 248 patients. Recently, the increase of rate of PDR with pylorus preservation permits to apply widely pancreato-, bilio-, and duodenoenteroanastomosis on the same jejunal loop.
本文介绍了305例因胰头和壶腹周围区域恶性及良性疾病行胰十二指肠切除术(PDR)的近期疗效。论证了在选择胰消化吻合术式时采用差异化方法的必要性。在胰腺主胰管未扩张且胰腺实质未改变的情况下,术后胰腺炎及致死率风险较高,57例患者组的致死率达29.8%。在主胰管直径大于3mm且实质有纤维化改变的患者中,多数将胰腺纳入消化道的术式效果良好,248例患者中的致死率为7.7%。近来,保留幽门的PDR手术比例增加,使得胰肠、胆肠和十二指肠肠吻合术能在同一空肠袢上广泛应用。