General Surgery Department, Second Affiliated Hospital, Hangzhou, China.
HPB (Oxford). 2004;6(3):154-60. doi: 10.1080/13651820410016598.
Over the past one hundred years, the development of pancreaticoduodenectomy (PD) has always involved the struggle against pancreatic leakage. Until now, leakage of the pancreatic anastomosis has remained a common and serious complication after PD. Various methods of dealing with the pancreatic stump for prevention of pancreatic anastomotic leakage have been described. No matter which method is used, however, pancreatic anastomotic leakage is still most likely to occur when anastomosis involves a normal and soft pancreas.
To perform a safe and reliable pancreaticoenteric anastomosis, we investigated the risk factors and potential mechanisms of occurrence of pancreatic leakage, including leakage from the needle hole and from the seam between two anastomosed structures, blood supply to the anastomosis and tension at the anastomosis. Based on these findings, we established a new pancreaticoenteric anastomosis procedure - binding pancreaticojejunostomy. The unique aspects of this procedure are as follows. The sero-muscular sheath of jejunum is bound to the invaginated pancreatic stump, so as to seal the gap between them; mucosa of the segment of jejunum that would eventually be in contact with the pancreatic stump is destroyed either chemically or by electric coagulation to promote healing. There is no needle hole on the jejunal surface of the anastomotic site.
From 1996 to 2003, a total of 227 consecutive patients were treated with this type of pancreaticojejunostomy in this institution. None of the patients developed a pancreatic anastomotic leak.
Binding pancreaticojejunostomy is a safe and reliable anastomotic procedure to effectively minimize leakage even when the texture of the pancreas is soft and normal.
在过去的一百年中，胰十二指肠切除术（PD）的发展始终涉及到对胰漏的抗争。直到现在，胰肠吻合口漏仍然是 PD 后常见且严重的并发症。为了预防胰吻合口漏，已经描述了各种处理胰残端的方法。然而，无论采用哪种方法，当吻合涉及正常和柔软的胰腺时，胰吻合口漏仍然最有可能发生。
为了进行安全可靠的胰肠吻合，我们研究了胰漏发生的危险因素和潜在机制，包括针孔漏和两个吻合结构之间的缝漏、吻合处的血供和吻合处的张力。基于这些发现，我们建立了一种新的胰肠吻合术——捆绑式胰肠吻合术。该手术的独特之处在于：空肠浆肌层鞘与套入的胰残端绑定，以封闭它们之间的间隙；即将与胰残端接触的空肠段黏膜用化学或电凝破坏，以促进愈合。吻合部位的空肠表面没有针孔。
1996 年至 2003 年，本机构共对 227 例连续患者采用这种胰肠吻合术进行治疗，无一例发生胰吻合口漏。
捆绑式胰肠吻合术是一种安全可靠的吻合术，即使胰腺质地柔软且正常，也能有效地将漏的风险降到最低。
