Boonnuch Wiroon, Akaraviputh Thawatchai, Lohsiriwat Darin
Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University Bangkok, Thailand.
J Med Assoc Thai. 2005 Apr;88(4):467-72.
Pancreaticoduodenectomy (Whipple's operation) represents a considerable surgical challenge. The operative mortality rate after Whipple's operation is still less than 5%. Recent studies show pancreaticojejunostomy (PJ) anastomosis is the "Achilles heel" of the procedure. The authors present the results of Whipple's operation without mortality which were performed in the Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
From January 1991 to December 2003, thirty-seven consecutive patients who underwent Whipple's operation were enrolled in the present study. The ages ranged from 33 to 79 years (mean 57.13). There were 19 male and 18 female patients. Twenty-nine of them underwent a pylorus preserving pancreaticoduodenctomy (PPPD). Construction of the PJ anastomosis was mostly performed by a dunking technique, that is, the invagination of the pancreatic resected end into the jejunum.
There was no postoperative mortality from anastomotic leakage. Surgical wound infections occurred in 7 patients, gastric atony in 2 patients, and PJ anastomosis leakage which created a fistula in 1 patient. All 37 patients were discharged in an improved condition following surgery. The median follow-up was 2 years (range: 4 month-11 years). Eighteen patients died from liver failure. Until now 19 patients are doing well.
The authors demonstrated that the dunking technique used for PJ anastomosis in Whipple's operation provided a good result without any mortality rate.
胰十二指肠切除术（惠普尔手术）是一项颇具挑战性的外科手术。惠普尔手术后的手术死亡率仍低于5%。近期研究表明，胰空肠吻合术（PJ）是该手术的“阿喀琉斯之踵”。本文作者展示了泰国曼谷玛希隆大学诗里拉吉医院医学院外科普通外科进行的无死亡病例的惠普尔手术结果。
1991年1月至2003年12月，本研究纳入了37例连续接受惠普尔手术的患者。年龄范围为33至79岁（平均57.13岁）。其中男性19例，女性18例。他们中有29例接受了保留幽门的胰十二指肠切除术（PPPD）。PJ吻合术大多采用套入技术构建，即将胰腺切除端套入空肠。
无因吻合口漏导致的术后死亡。7例发生手术伤口感染，2例出现胃无力，1例PJ吻合口漏形成瘘管。所有37例患者术后病情改善后出院。中位随访时间为2年（范围：4个月至11年）。18例患者死于肝衰竭。截至目前，19例患者情况良好。
作者证明，惠普尔手术中用于PJ吻合术的套入技术取得了良好效果，且无死亡率。
