Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA.
J Am Coll Surg. 2010 Jan;210(1):54-9. doi: 10.1016/j.jamcollsurg.2009.09.020. Epub 2009 Oct 28.
Pancreatic anastomotic failure has traditionally been a source of significant morbidity and potential mortality after pancreaticoduodenectomy. Both patient-derived and technical factors contribute to pancreatic anastomotic failure. From a technical standpoint, an "ideal" pancreaticojejunal anastomosis would meet the following criteria: applicable to all patients, easy to teach, and associated with a low rate of pancreatic anastomotic failure-related complications. The pancreaticojejunostomy described by one of the authors (LHB) meets the criteria for an "ideal" pancreaticojejunostomy.
We performed an audit of results of a consecutive series of patients at two institutions who underwent pancreaticojejunostomy using the described technique. Pancreaticojejunostomy after pancreaticoduodenectomy was performed in all cases using a novel two-layer technique consisting of an outer full thickness pancreas-to-seromuscular jejunal anastomosis and an inner duct-to-mucosal anastomosis. Incidences of pancreatic anastomotic failure (measured using the International Study Group of Pancreatic Fistula definition) and perioperative pancreatic anastomotic failure-related complications were analyzed.
One hundred eighty-seven patients underwent pancreaticojejunostomy after pancreaticoduodenectomy using the described technique. Overall mortality was 1.6%. The rate of clinically significant pancreatic anastomotic failure (International Study Group of Pancreatic Fistula grade B or C) was only 6.9%. There was no bleeding, reoperation, or mortality secondary to pancreatic anastomotic failure among patients in this series.
The novel pancreaticojejunostomy is applicable to all patients in whom the pancreatic duct can be identified, and it is associated with very low rates of significant postoperative morbidity and mortality. These findings support its routine use for pancreaticojejunal reconstruction after pancreaticoduodenectomy.
胰腺吻合口失败一直是胰十二指肠切除术后发生严重发病率和潜在死亡率的主要原因。患者相关和技术相关因素均导致胰腺吻合口失败。从技术角度来看，“理想的”胰肠吻合术应满足以下标准：适用于所有患者、易于教授、且与胰腺吻合口相关并发症的发生率低。作者之一（LHB）描述的胰肠吻合术符合“理想的”胰肠吻合术的标准。
我们对在两个机构接受描述技术进行胰肠吻合术的连续患者系列的结果进行了审核。在所有情况下，使用一种新的双层技术进行胰十二指肠切除术后的胰肠吻合术，该技术包括外层全层胰腺与浆肌层空肠吻合术和内层胰管与黏膜吻合术。分析了胰腺吻合口失败（使用国际胰腺瘘研究组定义测量）和围手术期胰腺吻合口相关并发症的发生率。
187 例患者采用描述的技术进行胰肠吻合术。总体死亡率为 1.6%。临床显著胰腺吻合口失败（国际胰腺瘘研究组分级 B 或 C）的发生率仅为 6.9%。本系列患者中无因胰腺吻合口失败导致的出血、再次手术或死亡。
新型胰肠吻合术适用于所有可识别胰管的患者，且术后严重发病率和死亡率非常低。这些发现支持其在胰十二指肠切除术后常规用于胰肠重建。
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