Nagakawa T, Konishi I, Ueno K, Ohta T, Kayahara M, Miyazaki I
2nd Department of Surgery (Department of Health Sciences), School of Medicine, Kanazawa University, Japan.
Hepatogastroenterology. 1997 Sep-Oct;44(17):1452-6.
BACKGROUND/AIMS: A variety of techniques for pancreaticojejunostomy have been employed with introduction of safer anastomosing methods in our department as an extended excision of the pancreas was performed. In this study, complications associated with the various techniques of pancreaticojejunostomy were investigated in order to find a safer anastomosing method.
The extent of excision and complication rate of three types of pancreaticojejunostomy (impaction method, subserosal anastomosis and non-division procedure) were investigated in 64 patients who underwent pancreatoduodenectomy for diseases of the pancreas and biliary system. The end-to-side anastomosis of the pancreas and jejunum without division of the jejunoserosal tunica muscularis (non-division method) is an anastomotic method with a low risk of suture insufficiency.
The incidence of secondary complications in the patients with suture insufficiency was higher than that in the patients with leakage of pancreatic juice. Once leakage of pancreatic juice and suture insufficiency occurred, the incidence of secondary complications was high after extended excision.
From these results, the non-division method was found to be a safe anastomosing method. After an extended excision is performed, intraperitoneal drainage is necessary.
背景/目的：随着我科开展胰腺扩大切除术并引入更安全的吻合方法，已采用多种胰肠吻合技术。本研究旨在调查各种胰肠吻合技术相关的并发症，以寻找更安全的吻合方法。
对64例因胰腺和胆道系统疾病接受胰十二指肠切除术的患者，研究了三种胰肠吻合术（嵌压法、浆膜下吻合术和不切断法）的切除范围和并发症发生率。胰腺与空肠端侧吻合且不切断空肠浆膜肌层（不切断法）是一种缝合不足风险较低的吻合方法。
缝合不足患者的继发并发症发生率高于胰液渗漏患者。一旦发生胰液渗漏和缝合不足，扩大切除术后继发并发症的发生率较高。
根据这些结果，发现不切断法是一种安全的吻合方法。在进行扩大切除术后，腹腔引流是必要的。
