Oida Takatsugu, Mimatsu Kenji, Kano Hisao, Kawasaki Atsushi, Kuboi Youichi, Fukino Nobutada, Kida Kazutoshi, Amano Sadao
Department of Surgery, Social Insurance Yokohama Central Hospital, Yokohama, Japan.
Hepatogastroenterology. 2012 Oct;59(119):2330-2. doi: 10.5754/hge10206.
BACKGROUND/AIMS: Patency of pancreaticogastrostomy (PG) is one of the most important factors affecting the function of the remnant pancreas and quality of life. We evaluated the early postoperative changes in pancreatic duct dilation after pancreaticoduodenectomy (PD) and PG with duct-to-mucosa anastomosis in patients with remarkably dilated pancreatic ducts.
We retrospectively analyzed 26 patients who had remarkably dilated pancreatic ducts (diameter, ≥7 mm) and who underwent PD followed by PG. They were divided into 2 groups on the basis of the endoscopic findings of the anastomotic orifice of PG: Group A, clear pancreatic duct orifice with pancreatic juice output; and Group B, unclear pancreatic duct orifice with pancreatic juice output.
The mean diameter of the duct of the remnant pancreas after the surgery was smaller in Group A than in Group B. With regards to postoperative pancreatic exocrine function, there was no significant difference between the 2 groups.
Invagination with duct-to-mucosa anastomosis is a useful technique to prevent pancreatic leakage; however, it is difficult to prevent inflammation and fibrosis around the anastomotic site of PG, and this can lead to anastomotic stricture in patients with a remarkably dilated pancreatic duct (diameter ≥7 mm).
背景/目的：胰胃吻合术（PG）的通畅性是影响残余胰腺功能和生活质量的最重要因素之一。我们评估了胰十二指肠切除术（PD）和采用导管对黏膜吻合术的PG术后早期胰管扩张的变化，这些患者的胰管明显扩张。
我们回顾性分析了26例胰管明显扩张（直径≥7mm）且接受了PD并随后接受PG的患者。根据PG吻合口的内镜检查结果将他们分为2组：A组，胰管开口清晰且有胰液流出；B组，胰管开口不清晰但有胰液流出。
术后A组残余胰腺导管的平均直径小于B组。关于术后胰腺外分泌功能，两组之间无显著差异。
导管对黏膜吻合术的内翻术是预防胰漏的有用技术；然而，难以预防PG吻合口周围的炎症和纤维化，这可能导致胰管明显扩张（直径≥7mm）的患者出现吻合口狭窄。
