Fujino Yasuhiro, Suzuki Yasuyuki, Matsumoto Ippei, Sakai Tetsuya, Ajiki Tetsuo, Ueda Takashi, Kuroda Yoshikazu
Department of Gastroenterological Surgery, Graduate School of Medicine, Kobe University, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
Surg Today. 2007;37(10):860-6. doi: 10.1007/s00595-007-3507-7. Epub 2007 Sep 26.
The purpose of this cohort was to evaluate the long-term patency of the anastomosis and the remnant pancreatic functions.
Fifty-six consecutive patients undergoing a pancreaticoduodenectomy with pancreatic duct invagination anastomosis were enrolled in this study. During the follow-up, changes in the remnant pancreatic duct size, pancreatic exocrine and endocrine functions, and nutritional status were monitored.
No seriously activated pancreatic fistula, no hemorrhagic complications, no reoperations, and no in-hospital deaths were observed after surgery. A dilatation of remnant pancreatic duct was detected a total of 37 times (51%) during annual computed tomography (CT) evaluations. Pancreatic dysfunctions were observed in a considerable number of patients (exocrine 4/12, 9/14, and 8/16, endocrine 9/35, 8/27, and 4/16 at 1, 2, and 3 postoperative years, respectively). Functional declines in the remnant pancreas, duct dilatation, and a decrease in the body mass index were observed from the first year. However, these data did not progressively deteriorate thereafter, at least during the first 3 postoperative years. This study demonstrated a significant correlation between the duct dilatation and endocrine dysfunction.
Our pancreatic duct invagination anastomosis resulted in somewhat limited long-term outcomes, although it did prevent serious complications in the short-term.
本队列研究的目的是评估吻合口的长期通畅情况以及残余胰腺功能。
本研究纳入了56例连续接受胰管内翻吻合术的胰十二指肠切除术患者。在随访期间，监测残余胰管大小、胰腺外分泌和内分泌功能以及营养状况的变化。
术后未观察到严重的激活型胰瘘、出血并发症、再次手术及院内死亡。在年度计算机断层扫描（CT）评估中，共检测到37次（51%）残余胰管扩张。相当数量的患者出现了胰腺功能障碍（术后1、2和3年时，外分泌功能障碍分别为4/12、9/14和8/16，内分泌功能障碍分别为9/35、8/27和4/16）。从第一年起，观察到残余胰腺功能下降、导管扩张和体重指数降低。然而，至少在术后的前3年，这些数据此后并未逐渐恶化。本研究表明导管扩张与内分泌功能障碍之间存在显著相关性。
我们的胰管内翻吻合术虽然在短期内确实预防了严重并发症，但其长期效果较为有限。
