Bradbeer J W, Johnson C D
Mayday University Hospital, Thornton Heath, Surrey.
Ann R Coll Surg Engl. 1990 Jul;72(4):266-9.
Although the mortality following pancreaticoduodenectomy has fallen and is now below 5%, overall 14% of patients develop a leak at the pancreatic anastomosis. This complication carries a 24% mortality rate when pancreaticojejunostomy is the method of reconstruction. In order to reduce the incidence of this complication, pancreaticogastrostomy can be performed following pancreaticoduodenectomy. A total of 41 patients underwent this operation between 1968 and 1989. The indications for operations were carcinoma of the head of the pancreas (n = 19), carcinoma of the ampulla (n = 12), carcinoma of the lower end of the common bile duct (n = 6), chronic pancreatitis (n = 3) and one patient with a nonfunctioning islet cell tumour. One patient developed a pancreatic fistula which closed spontaneously in 5 days. This patient is alive and well 36 months after operation. Pancreaticogastrostomy with pancreatic duct to gastric mucosa anastomosis is recommended as a safe and straight-forward method of reconstruction following pancreaticoduodenectomy.
尽管胰十二指肠切除术后的死亡率有所下降，目前已低于5%，但总体上仍有14%的患者在胰肠吻合处发生渗漏。当采用胰空肠吻合术作为重建方法时，这种并发症的死亡率为24%。为了降低这种并发症的发生率，胰十二指肠切除术后可采用胰胃吻合术。1968年至1989年间共有41例患者接受了该手术。手术适应证包括胰头癌（n = 19）、壶腹癌（n = 12）、胆总管下端癌（n = 6）、慢性胰腺炎（n = 3）以及1例无功能胰岛细胞瘤患者。1例患者发生胰瘘，5天后自行闭合。该患者术后36个月存活且状况良好。推荐采用胰管与胃黏膜吻合的胰胃吻合术作为胰十二指肠切除术后安全、简便的重建方法。
