Kapoor Vinay K, Sharma Ajay, Behari Anu, Singh Rajneesh K
Department of Surgical Gastroenterology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, India.
JOP. 2006 Nov 10;7(6):608-15.
Pancreaticoduodenectomy continues to have a high morbidity (40-50%). Major complications of pancreaticoduodenectomy include leaks from the pancreaticojejunostomy and an intra-abdominal bleed from the gastroduodenal artery stump. The omentum has been used for the prevention of anastomotic leaks.
The use of omental flaps to prevent a pancreaticojejunostomy leak and bleeding complications from a pancreaticojejunostomy leak after pancreaticoduodenectomy.
Seventy-seven patients who underwent a pancreaticoduodenectomy.
Pedicled flaps were made from the greater omentum. One omental flap was wrapped over the pancreaticojejunostomy (separating it from gastroduodenal artery stump) and the second omental flap was wrapped over the duodenojejunostomy.
Omental flaps were used in 25 patients (Group 1) and a pancreaticoduodenectomy was done without an omental flap in 52 patients (Group 2). None of the 25 patients had any complications related to the omental flap. A pancreaticojejunostomy leak occurred in 4/25 (16%) patients in Group 1 and in 11/52 (21%) patients in Group 2 (P=0.762). None of the pancreaticojejunostomy leaks in Group 1 was clinically significant. The pancreaticojejunostomy leaks in Group 2 were responsible for intra-abdominal bleeding in 2 patients (1 died) and for intra-abdominal abscess in 5 patients (1 died). Neither of the 2 (8%) deaths in Group 1 was related to a complication from pancreaticojejunostomy. There were 5 (10%) deaths in Group 2 (three following an intra-abdominal bleed, one due to bleeding from the gastrojejunostomy, and one due to sepsis following a pancreaticojejunostomy leak). Thus, there were four patients in Group 2 who died from a pancreaticojejunostomy leak and/or a major vascular bleed vs. none in Group 1 (P=0.298).
The use of omental flaps is a simple technique for decreasing the risk of major vascular complications related to pancreaticojejunostomy leak following pancreaticoduodenectomy.
胰十二指肠切除术的发病率仍然很高（40%-50%）。胰十二指肠切除术的主要并发症包括胰肠吻合口漏和胃十二指肠动脉残端腹腔内出血。大网膜已被用于预防吻合口漏。
使用大网膜瓣预防胰十二指肠切除术后胰肠吻合口漏及胰肠吻合口漏引起的出血并发症。
77例行胰十二指肠切除术的患者。
带蒂瓣取自大网膜。一个大网膜瓣包裹在胰肠吻合口上（使其与胃十二指肠动脉残端隔开），第二个大网膜瓣包裹在十二指肠空肠吻合口上。
25例患者使用了大网膜瓣（第1组），52例患者未使用大网膜瓣进行胰十二指肠切除术（第2组）。25例患者中无一例出现与大网膜瓣相关的并发症。第1组4/25（16%）的患者发生胰肠吻合口漏，第2组11/52（21%）的患者发生胰肠吻合口漏（P=0.762）。第1组的胰肠吻合口漏均无临床意义。第2组的胰肠吻合口漏导致2例患者腹腔内出血（1例死亡），5例患者腹腔内脓肿（1例死亡）。第1组的2例（8%）死亡均与胰肠吻合口并发症无关。第2组有5例（10%）死亡（3例死于腹腔内出血，1例死于胃空肠吻合口出血，1例死于胰肠吻合口漏后败血症）。因此，第2组有4例患者死于胰肠吻合口漏和/或严重血管出血，而第1组无死亡病例（P=0.298）。
使用大网膜瓣是一种简单的技术，可降低胰十二指肠切除术后与胰肠吻合口漏相关的严重血管并发症的风险。
