Ma You-Gang, Li Xiao-Song, Chen Han, Wu Meng-Cao
Department of Second Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai 200438, China.
Hepatobiliary Pancreat Dis Int. 2002 Nov;1(4):611-3.
To explore the way to lower the morbidity and mortality of patients after pancreaticoduodenectomy.
Between March 1998 and March 2001, 26 patients with periampullary tumors received pancreaticoduodenectomy (PD) with Roux-Y anastomosis to reconstruct the digestive tract. Of these patients, 6 had ductal cell carcinoma at the head of the pancreas, 8 distal common bile duct carcinoma, 5 ampullar adenocarcinoma of the Vater, 6 duodenal adenocarcinoma, and 1 duodenal malignant lynphoma. A 30-40 cm free vascularized segment of the proximal jejunum was taken and pulled up to the bed of the duodenum for end-to-end pancreaticojejunostomy, end-to-side choledocojejunostomy or side-to-side jejunojejunostomy by a single loop.
The operative mortality was zero. Postoperative intraabdominal hemorrhage occurred in 2 patients, but no leakage during pancreaticojejunostomy or choledocojejunostomy as well as abdominal infection. The patients were discharged from the hospital on the tenth to fourteenth day after operation. Follow-up for 5 to 36 months (mean 21 months) revealed chronic steatorrhea and malnutrition in one patient (3.85%), and good digestive function and normal nutritional status in 25 (96.15%). No bile reflux gastritis, retrograde infection, anastomotic ulcer, and dumping syndrome were observed.
Our results show that this procedure can effectively reduce the morbidity and mortality of patients after PD.
探讨降低胰十二指肠切除术后患者发病率和死亡率的方法。
1998年3月至2001年3月，26例壶腹周围肿瘤患者接受了胰十二指肠切除术（PD），采用Roux-Y吻合术重建消化道。其中，6例为胰腺头部导管细胞癌，8例为胆总管远端癌，5例为 Vater壶腹腺癌，6例为十二指肠腺癌，1例为十二指肠恶性淋巴瘤。取一段30 - 40 cm游离的带血管蒂近端空肠段，上提至十二指肠床，行端端胰空肠吻合术、端侧胆总管空肠吻合术或单袢侧侧空肠吻合术。
手术死亡率为零。2例患者术后发生腹腔内出血，但胰空肠吻合术或胆总管空肠吻合术均无渗漏及腹腔感染。患者术后第10至14天出院。随访5至36个月（平均21个月），1例患者（3.85%）出现慢性脂肪泻和营养不良，25例（96.15%）消化功能良好，营养状况正常。未观察到胆汁反流性胃炎、逆行感染、吻合口溃疡及倾倒综合征。
我们的结果表明，该手术可有效降低胰十二指肠切除术后患者的发病率和死亡率。
