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[采用端环胰肠吻合术的胰十二指肠切除术的近期结果]

[Immediate results of pancreatoduodenal resection with end-loop pancreatoenteroanastomosis].

作者信息

Onopriev V I, Manuĭlov A M, Rogal' M L, Voskanian S E

出版信息

Khirurgiia (Mosk). 2003(5):24-30.

Abstract

Immediate results of 151 pancreatoduodenal resections (PDR) were analyzed. This surgery was performed for tumors of gastropancreatoduodenal region in 88.1% patients, for chronic complicated pancreatitis--in 11.9%. Pylorus-saving PDR was performed in 82.8% patients, in combination with stomach resection--in 17.2%. Extended and regional pancreatectomy was performed in 20.3% patients with tumors of periampullar zone, extended lymphadenectomy--in 44.4%. Pancreatoenteroanastomosis was created in 82.8% patients, end-loop Wirsungenteroanastomosis by original author's method--in 52.3% of them, traditional Wirsungenteroanastomosis end-to-side--in 30.5%, complete external drainage of pancreas stump was performed in 13.9%, suturing of pancreas stump--in 2.6%, pancreatogastroanastomosis was created in 1 (0.7%) patient. There was no insufficiency of pancreatoduodenoanastomosis performed with original method, while in traditional Wirsungenteroanastomosis it was seen in 4.4% patients. End-loop anastomosis permitted to reduce number of complications after PDR 1.6--3 times. General lethality was 11.3%, in end-loop anastomosis--3.8% that significantly lower than after other methods of treatment of pancreas stump.

摘要

对151例胰十二指肠切除术(PDR)的近期结果进行了分析。88.1%的患者因胃胰十二指肠区域肿瘤接受该手术,11.9%的患者因慢性复杂性胰腺炎接受手术。82.8%的患者实施了保留幽门的PDR,17.2%的患者联合胃切除术。20.3%的壶腹周围区肿瘤患者实施了扩大和区域性胰腺切除术,44.4%的患者实施了扩大淋巴结清扫术。82.8%的患者进行了胰肠吻合,其中52.3%的患者采用原作者方法进行端环式胰管空肠吻合,30.5%的患者采用传统的端侧胰管空肠吻合,13.9%的患者对胰腺残端进行了完全外引流,2.6%的患者对胰腺残端进行了缝合,1例(0.7%)患者进行了胰胃吻合。采用原方法进行的胰十二指肠吻合未出现吻合口漏,而传统的胰管空肠吻合有4.4%的患者出现吻合口漏。端环吻合使PDR术后并发症数量减少了1.6至3倍。总体死亡率为11.3%,端环吻合术后为3.8%,明显低于其他胰腺残端处理方法。

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