Hashimoto Daisuke, Hirota Masahiko, Chikamoto Akira, Beppu Toru, Baba Hideo
Hepatogastroenterology. 2014 Mar-Apr;61(130):489-92.
BACKGROUND/AIMS: Post-operative leakage from pancreatic anastomosis remains an important cause of morbidity in pancreaticoduodenectomy. It also contributes to prolonged hospitalization and mortality. We have developed a new inserting end-to -side pancreatico-jejunostomy without stiches on the pancreatic cut end or pancreatic duct.
In this novel anastomosis technique, the pancreatic stump is first sunk into jejunum deeply in an end-to-side manner and tightened with a purse string in the bowel serosa. The pancreatic stump could be inserted completely inserting into the jejunum, independent of the size of the pancreas and jejunum. We performed this new anastomosis to 21 patients prospectively in Kumamoto University Hospital from April to October in 2012.
Postoperative pancreatic fistula was not observed at all in the 21 patients. There was no hospital death, whereas 6 patients developed postoperative complications. Importantly, one patient developed hemorrhage from pancreatic cut end into the jejunum.
This new method would be expected to minimize leakage from pancreaticojejunostomy. Further studies should be planned in a randomized controlled trial compared with another traditional pancreatico-jejunostomy.
背景/目的：胰十二指肠切除术后胰肠吻合口漏仍是发病的重要原因。它还会导致住院时间延长和死亡率上升。我们开发了一种新的端侧胰肠吻合术，胰管断端或胰腺断端均无需缝合。
在这种新的吻合技术中，首先将胰腺残端以端侧方式深深埋入空肠，并在肠浆膜层用荷包缝合收紧。胰腺残端能够完全插入空肠，与胰腺和空肠的大小无关。2012年4月至10月，我们在熊本大学医院对21例患者前瞻性地实施了这种新的吻合术。
21例患者均未观察到术后胰瘘。无住院死亡病例，然而有6例患者出现术后并发症。重要的是，有1例患者发生胰腺断端向空肠内出血。
这种新方法有望使胰肠吻合口漏降至最低。与另一种传统胰肠吻合术相比，应计划进一步开展随机对照试验研究。
