Kwon Yong Jin, Ahn Byung Kyu, Park Hwon Kyum, Lee Kwang Soo, Lee Kyeong Geun
Hepatogastroenterology. 2013 Sep;60(126):1488-91. doi: 10.5754/hge121198.
BACKGROUND/AIMS: Pancreaticoduodenectomy is associated with a high incidence of postoperative morbidity, and pancreatic fistulas are the most important complication. We therefore designed a modified method of pancreaticojejunostomy using reinforcing suture on the pancreatic stump.
The procedure is performed as follow: first, insert a soft rubber catheter into the pancreatic duct, then make reinforcing sutures with 3-0 vicryl. These sutures are parallel to the cut edge of the pancreatic stump, and 5mm from the cut edge. The whole layer of jejunum is sewed to the pancreas including the reinforcing sutures.
Between July 2002 and November 2011, 52 consecutive cases of pancreaticoduodenectomy were performed using this method. We used The International Study Group for Pancreatic Surgery (ISGPS) severity grading for postoperative pancreatic fistula (POPF) and delayed gastric emptying (DGE). There was 1 grade A fistula (1.9%), 16 grade B fistulas (30.8%), and 2 grade C fistulas (3.8%).
This method of one layer anastomosis is straightforward and practicable; hence it saves operative time, and is not much affected by lack of familiarity with the surgical technique. Even if it does not actually prevent pancreatic fistula formation, it does prevent the life-threatening complete breakdown of the pancreaticojejunostomy.
背景/目的：胰十二指肠切除术术后并发症发生率较高，其中胰瘘是最重要的并发症。因此，我们设计了一种在胰腺残端使用加强缝合的改良胰空肠吻合方法。
手术步骤如下：首先，将一根软橡胶导管插入胰管，然后用3-0可吸收缝线进行加强缝合。这些缝线与胰腺残端的切缘平行，距离切缘5毫米。将空肠全层缝合至胰腺，包括加强缝线。
2002年7月至2011年11月期间，连续52例患者采用该方法进行了胰十二指肠切除术。我们采用国际胰腺外科研究组（ISGPS）对术后胰瘘（POPF）和胃排空延迟（DGE）的严重程度分级。有1例A级瘘（1.9%），16例B级瘘（30.8%），2例C级瘘（3.8%）。
这种单层吻合方法简单可行；因此节省了手术时间，且不太受手术技术不熟练的影响。即使它实际上不能防止胰瘘形成，但确实能防止危及生命的胰空肠吻合完全破裂。
