Tsuji M, Kimura H, Konishi K, Yabushita K, Maeda K, Kuroda Y
Department of Surgery, Toyama Prefectural Central Hospital, Japan.
Surgery. 1998 Jun;123(6):617-21.
Pancreaticojejunostomy is the most problematic anastomosis in the reconstruction after pancreaticoduodenectomy. In the past, much of the morbidity and mortality associated with this operation was related to problems with this anastomosis. Recent data, however, suggest that the use of duct-to-mucosa sutures has led to a marked drop in both morbidity and mortality associated with pancreaticojejunostomy.
Among the 300 patients who underwent pancreaticoduodenectomy, including pylorus-preserving pancreaticoduodenectomy, 87 patients underwent traditional pancreaticojejunostomy by invagination of the end of the pancreas into the bowel (group B). Recently three-layer anastomosis was created in 213 patients. The outer layer was created between the pancreatic capsule and the serosa of jejunum. The middle layer was created between the pancreatic parenchyma and the seromuscular wall of jejunum. The inner layer was placed between the pancreatic duct and a small opening in the antimesenteric border of the jejunal mucosa. Among the 213 patients, the inner anastomosis was created with interrupted absorbable sutures (group A1) in 93 patients and continuous absorbable sutures (group A2) in 120 patients.
The three groups were similar with respect to age, gender, and primary disease. In the anastomosis, the incidence of leakage in group A2 (4.2%) was significantly less than in groups B (17.2%, p < 0.01) and A1 (11.8%, p < 0.05). The operative mortality rates were 3.2% in group A1, 1.7% in group A2, and 5.7% in group B.
We recommend continuous anastomosis of the pancreatic duct and jejunal mucosa as a safe procedure after pancreaticoduodenectomy.
胰肠吻合术是胰十二指肠切除术后重建中最具挑战性的吻合方式。过去，该手术的许多发病率和死亡率都与这种吻合相关的问题有关。然而，最近的数据表明，使用胰管-黏膜缝合已导致与胰肠吻合术相关的发病率和死亡率显著下降。
在300例行胰十二指肠切除术（包括保留幽门的胰十二指肠切除术）的患者中，87例患者采用将胰尾端套入肠内的传统胰肠吻合术（B组）。最近，213例患者采用了三层吻合术。外层在胰腺包膜和空肠浆膜之间构建。中层在胰腺实质和空肠浆肌层壁之间构建。内层置于胰管和空肠黏膜系膜对侧缘的一个小开口之间。在213例患者中，93例患者采用间断可吸收缝线进行内层吻合（A1组），120例患者采用连续可吸收缝线进行内层吻合（A2组）。
三组在年龄、性别和原发疾病方面相似。在吻合方面，A2组的漏发生率（4.2%）显著低于B组（17.2%，p<0.01）和A1组（11.8%，p<0.05）。A1组的手术死亡率为3.2%，A2组为1.7%，B组为5.7%。
我们推荐胰十二指肠切除术后采用胰管与空肠黏膜连续吻合作为一种安全的手术方式。
