Peng Shu-you, Li Jiang-tao, Cao Li-ping, Zhu Ling-hua, Hong De-fei, Li Ning, Liu Ying-bin, Wang Yi-fan, Yu Yuan-quan
Department of Surgery, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou 310009, China.
Zhonghua Wai Ke Za Zhi. 2011 Sep 1;49(9):834-8.
To study the feasibility of binding pancreatic duct to mucosa anastomosis (BDM)-a complementary procedure to both binding pancreaticojejunostomy and binding pancreaticogastrostomy.
(1) Animal experimental study:gastrostomy and jejunostomy were performed on six adult New Zealand rabbits. The gastrostomy and jejunostomy shared a same stent (rubber urethral catheter, silicone tube or plastic infusion tube). Both ends of the stent were placed in gastric and enteric cavity. Purse-string suture was performed around the stent before the jejunum and the stomach were brought together for fixation by few stitches. And to observe whether the purse-string suture around a plastic tube, rubber tube or silicon tube inserted into jejunum and/or stomach can prevent leaking out of the jejunal or gastric content to cause peritonitis. (2) Clinically 7 patients were performed with BDM anastomosis. The procedure was consisted of five steps: preparation of the pancreatic stump;preparation of the jejunum; preparation of the fixing sutures between the pancreatic stump and the jejunum; implementation of the anastomosis; lastly, fixation of the jejunum beside the pancreas stump. Post-operative periodic examination of the blood amylase and the amylase in the abdominal drainage. Pancreatic fistula was classified in to two categories: parenchymal fistula (pancreatic cut surface fistula) and anastomotic leakage.
Animal experiment did not show any leakage around the plastic tube or silicon tube inserted into jejunum and(or) stomach. There was no anastomotic leak in all the patients. There was transient increase of amylase in two cases, but the volume of drainage did not exceed 50 ml/d and the recovery of the patients was not affected.
BDM is a simple, safe and easy procedure to perform. It provides to the surgeons with a new option in different situations to achieve the most ideal surgical result.
研究胰管与黏膜吻合术（BDM）的可行性——一种作为胰空肠吻合术和胰胃吻合术补充的手术方式。
（1）动物实验研究：对6只成年新西兰兔进行胃造口术和空肠造口术。胃造口术和空肠造口术共用一个支架（橡胶尿道导管、硅胶管或塑料输液管）。支架两端置于胃腔和肠腔内。在空肠和胃并拢用几针固定之前，围绕支架进行荷包缝合。观察插入空肠和/或胃的塑料管、橡胶管或硅胶管周围的荷包缝合能否防止空肠或胃内容物漏出导致腹膜炎。（2）临床对7例患者实施BDM吻合术。该手术包括五个步骤：胰残端的准备；空肠的准备；胰残端与空肠之间固定缝线的准备；吻合术的实施；最后，将空肠固定在胰残端旁。术后定期检测血淀粉酶和腹腔引流液中的淀粉酶。胰瘘分为两类：实质瘘（胰切面瘘）和吻合口漏。
动物实验中，插入空肠和（或）胃的塑料管或硅胶管周围未出现任何渗漏。所有患者均未发生吻合口漏。2例患者淀粉酶短暂升高，但引流量不超过50 ml/d，患者恢复未受影响。
BDM是一种操作简单、安全且容易实施的手术。它为外科医生在不同情况下提供了一种新的选择，以实现最理想的手术效果
