Osada Shinji, Imai Hisashi, Okumura Naoki, Tokuyama Yasuharu, Hosono Yoshiki, Sakashita Fumio, Sugiyama Yasuyuki
Surgical Oncology, Gifu University School of Medicine, Gifu city, Japan.
Hepatogastroenterology. 2006 Mar-Apr;53(68):296-300.
BACKGROUND/AIMS: A new method of reconstructing the pancreatic stump after pancreatoduodenectomy (PD) is necessary to improve the postoperative mortality rate. Thus, we modified the pancreatoenteric procedure to reduce anastomotic leakage from the pancreatic stump after PD, and we conducted a study to evaluate the usefulness of the new procedure on the basis of patients' postoperative condition.
We compared the postoperative condition of 21 patients who underwent PD with the new separated loop (SL) reconstruction (6 men, 11 women; mean age, 67.7+/-7.2 years) to that of 31 patients (12 men, 19 women; mean age, 66.8+/-10.3 years) who underwent PD with pancreatogastrostomy (PG). In the SL reconstruction procedure, the proximal jejunum is brought up behind the colon, and an end-to-side choledochojejunostomy is made with a single layer of interrupted sutures. Approximately 20cm of the jejunum is fitted with a fixed stomach tube for postoperative enteral feeding, and the cut proximal jejunum is positioned next to the pancreatic stump. A pancreatic tube is inserted into the lumen of the pancreatic duct and fixed without closing the pancreatic duct. Pancreatojejunostomy is achieved as an end-to-end anastomosis with the pancreatic stump telescoping into the proximal jejunum. Approximately 20cm of the jejunum is anastomosed side-to-end to the stomach, and end-to-side jejunojejunostomy is made to complete a Y-type reconstruction. Each patient's postoperative condition was also assessed on the basis of serum albumin (ALB), cholinesterase and total cholesterol (T-CHO) levels on postoperative days (PODs) 14 and 28.
A high level of amylase in drainage fluid was noted in two (6.5%) and delayed gastric emptying in four (12.9%) of the patients in the PG group. There were no complications in the SL group. Postoperative levels of ALB on POD 14 and T-CHO on POD 28 were significantly higher than in the PG group.
The SL method is safe and does not induce complications after PD. Our results indicate that this method may provide a favored outcome.
背景/目的：为提高胰十二指肠切除术（PD）后的术后死亡率，需要一种新的胰残端重建方法。因此，我们改良了胰肠吻合术以减少PD术后胰残端的吻合口漏，并根据患者术后情况开展了一项研究来评估新方法的有效性。
我们比较了21例行新的分离袢（SL）重建PD手术患者（6例男性，11例女性；平均年龄67.7±7.2岁）与31例行胰胃吻合术（PG）的PD手术患者（12例男性，19例女性；平均年龄66.8±10.3岁）的术后情况。在SL重建手术中，将空肠近端提到结肠后方，用单层间断缝合进行胆总管空肠端侧吻合。约20cm空肠安装固定胃管用于术后肠内营养，切断的空肠近端置于胰残端旁。将胰管插入胰管腔内并固定，不封闭胰管。胰空肠吻合采用胰残端套入空肠近端的端端吻合。约20cm空肠与胃行端侧吻合，空肠空肠端侧吻合以完成Y型重建。还根据术后第14天和第28天的血清白蛋白（ALB）、胆碱酯酶和总胆固醇（T-CHO）水平评估每位患者的术后情况。
PG组有2例患者（6.5%）引流液淀粉酶水平高，4例患者（12.9%）出现胃排空延迟。SL组无并发症发生。术后第14天的ALB水平和术后第28天的T-CHO水平均显著高于PG组。
SL方法安全，PD术后不引发并发症。我们的结果表明该方法可能会带来较好的结果。
