Amano H, Takada T, Ammori B J, Yasuda H, Yoshida M, Uchida T, Isaka T, Toyota N, Kodaira S, Hijikata H, Takada K
First Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
Hepatogastroenterology. 1998 Nov-Dec;45(24):2382-7.
BACKGROUND/AIMS: To clarify whether the pancreatic duct remains patent during long-term follow-up of patients after pancreaticogastrostomy. In a previous study of pancreaticogastrostomy with post-operative follow up for 3 years after surgery, we found that the orifice of the pancreatic duct was difficult to detect in some patients because of swelling of the gastric mucosa. Previous studies have not examined pancreatic duct patency during long-term follow-up.
Between July 1985 and August 1989, 20 patients underwent a pylorus-preserving pancreaticoduodenectomy with reconstruction by pancreaticogastrostomy. Five of these patients were followed up post-operatively for more than 9 years to determine the patency of the pancreatic duct. All pancreatic anastomoses were performed by the telescopic method.
All 5 patients were female, with a mean age of 65.4 years (range: 54-75). Median post-operative follow-up was 10.8 years (range: 9-12). The indications for surgery were carcinoma of the ampulla of Vater in 4 patients and chronic pancreatitis in 1 patient. Pancreatic duct patency was confirmed in 4 patients by gastroscopy and pancreatography. However, the anastomotic orifice could not be detected in the remaining patient because of complete coverage by the gastric mucosa. In this patient, pancreatic exocrine and endocrine function deteriorated with dilation of the distal pancreatic duct. The patient underwent a second operation involving dissociation of the pancreatico-gastric anastomosis and resection of about 1 cm of the fibrous, proximal portion of the pancreas. Reconstruction was performed with a Roux-en-Y pancreaticojejunostomy and a mucosa-to-mucosa anastomosis.
Although pancreaticogastrostomy has been applied as a safe and straightforward method for reconstruction after pancreaticoduodenectomy, anastomotic stenosis is a potential late complication of this approach.
背景/目的：明确在胰胃吻合术后患者的长期随访中胰管是否保持通畅。在之前一项对胰胃吻合术患者术后3年随访的研究中，我们发现由于胃黏膜肿胀，部分患者难以检测到胰管开口。既往研究未对长期随访期间的胰管通畅情况进行检查。
1985年7月至1989年8月期间，20例患者接受了保留幽门的胰十二指肠切除术，并采用胰胃吻合术进行重建。其中5例患者术后随访超过9年，以确定胰管的通畅情况。所有胰肠吻合均采用套入法进行。
所有5例患者均为女性，平均年龄65.4岁（范围：54 - 75岁）。术后中位随访时间为10.8年（范围：9 - 12年）。手术指征为4例患者为 Vater 壶腹癌，1例患者为慢性胰腺炎。4例患者通过胃镜检查和胰管造影证实胰管通畅。然而，由于胃黏膜完全覆盖，其余1例患者无法检测到吻合口。该患者胰外分泌和内分泌功能随着胰管远端扩张而恶化。患者接受了第二次手术，包括松解胰胃吻合口并切除胰腺近端约1 cm的纤维组织部分。采用 Roux-en-Y 胰空肠吻合术和黏膜对黏膜吻合术进行重建。
尽管胰胃吻合术已被用作胰十二指肠切除术后安全且直接的重建方法，但吻合口狭窄是该方法潜在的晚期并发症。
