Khan Abdaal W, Agarwal Anil K, Davidson Brian R
University Department of Surgery, Royal Free Hospital Hampstead NHS Trust, Royal Free Campus, Royal Free and University College Medical School, London, UK.
Dig Surg. 2002;19(3):199-204. doi: 10.1159/000064213.
Over the last decade the operative mortality associated with pancreaticoduodenectomy (PD) has decreased. Pancreatic anastomotic leaks resulting in pancreatic bed sepsis and fistulae, however, remain a significant cause of both morbidity and mortality. The optimal method of reconstruction to minimise pancreatic leaks is controversial.
To review the experience of Roux loop duct-to-mucosa pancreaticojejunostomy in a consecutive series of patients undergoing pancreatic head resection.
Over the 6-year period (1993-1998), 41 patients underwent pancreatic head resections for benign (n = 5) and malignant disease (n = 36). There were 19 males and the median age was 62 years (range 29-83). An isolated Roux loop pancreaticojejunostomy was performed in all cases.
Median duration of surgery was 8 h and the median postoperative stay was 16 days. The mean peri-operative blood transfusion was 2.9 units (SD 1.9). The incidence of major complications was 12% and there was 1 death (2.4%). There were no pancreatic leaks or fistulae.
The low complication rate and the absence of pancreatic fistulae in this series would suggest that Roux loop duct-to-mucosa pancreatic reconstruction should be more widely adopted.
在过去十年中，胰十二指肠切除术（PD）相关的手术死亡率有所下降。然而，胰瘘导致胰床感染和脓肿，仍然是发病和死亡的重要原因。关于采用何种最佳重建方法以尽量减少胰瘘，目前仍存在争议。
回顾在一系列连续接受胰头切除术的患者中采用Roux袢导管对黏膜胰空肠吻合术的经验。
在6年期间（1993 - 1998年），41例患者因良性疾病（n = 5）和恶性疾病（n = 36）接受了胰头切除术。其中男性19例，中位年龄为62岁（范围29 - 83岁）。所有病例均采用孤立的Roux袢胰空肠吻合术。
手术中位时长为8小时，术后中位住院时间为16天。围手术期平均输血量为2.9单位（标准差1.9）。主要并发症发生率为12%，死亡1例（2.4%）。未发生胰瘘。
本系列中低并发症发生率及无胰瘘表明，Roux袢导管对黏膜胰腺重建术应更广泛采用。
