• 1. 解放軍第二炮兵總醫(yī)院肝膽胃腸病研究所(北京 100088);;
  • 2. 解放軍總醫(yī)院(北京 100853);

目的  探討胰腸吻合的新方法,降低胰瘺等并發(fā)癥發(fā)生的概率。
方法  通過可吸收止血網(wǎng)帶及耳腦膠的靈活使用,行改良無縫合的胰管空腸吻合術(shù)10例,觀察手術(shù)完成情況;術(shù)后監(jiān)測(cè)血常規(guī)、血淀粉酶和脂肪酶以及引流液淀粉酶和脂肪酶水平;術(shù)后1個(gè)月處死動(dòng)物觀察胰腸吻合口情況并取局部組織行病理學(xué)檢查。
結(jié)果  10例動(dòng)物的手術(shù)時(shí)間為(35±10) min,其中9例術(shù)后恢復(fù)順利并一直存活,腹腔引流液及血淀粉酶和脂肪酶均正常;另1例動(dòng)物并發(fā)胰瘺,于術(shù)后第2 天開始出現(xiàn)明顯腹脹,腹水淀粉酶升高達(dá)10 000u/L,術(shù)后第10 天死亡,經(jīng)解剖發(fā)現(xiàn)胰管支撐管脫落,胰腺周圍感染。
結(jié)論  改良無縫合胰管空腸吻合術(shù)與傳統(tǒng)胰腸吻合術(shù)式對(duì)比,同樣可以控制胰瘺發(fā)生的幾率,但手術(shù)更簡便、實(shí)用; 該術(shù)式有望成為胰腺吻合的常規(guī)手術(shù)方法之一。

引用本文: 朱震宇,黃志強(qiáng). 胰腸吻合方法的探索. 中國普外基礎(chǔ)與臨床雜志, 2012, 19(4): 368-371. doi: 復(fù)制

1. Yeo CJ, Cameron JL, Sohn TA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s:pathology, complications,and outcomes [J]. Ann Surg, 1997, 226(3):248-257.
2. Yeo CJ, Cameron JL, Maher MM, et a1. A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy [J]. Ann Surg, 1995,222(4): 580-588..
3. Staley CA, Lee JE, Cleary KR, et a1. Preoperative chemoradiation,pancreaticoduodenectomy,and intraoperative radiation therapy for adenocarcinoma of the pancreatic head [J]. Am J Surg, 1996, 171(1): 118-124..
4. Matsumoto Y, Fujii H, Miura K, et a1. Successful pancreatojejunal anastomosis for pancreatoduodenectomy [J]. Surg Gynecol Obstet, 1992, 175(6): 555-562..
5. Cameron JL, Pitt HA, Yeo CJ, et a1. One hundred and fortyfive consecutive pancreaticoduodenectomies without mortality [J]. Ann Surg, 1993, 217(5): 430-435.
6. 李海民, 竇科蜂, 宋振順, 等. 套人式雙層連續(xù)縫合加捆綁在胰腸吻合術(shù)中的應(yīng)用 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007,14(4): 480..
7. 彭淑牖, 吳育連, 彭承宏, 等. 捆綁式胰腸吻合術(shù)( 附28 例報(bào)告) [J]. 中華外科雜志, 1997, 35(3):158-159..
8. 張春秋, 王國華, 彭曉暉, 等. 捆綁式胰腸吻合術(shù)在預(yù)防胰十二指腸切除術(shù)后胰瘺發(fā)生中的臨床應(yīng)用 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008, 15(8): 565-566..
9. Bartoli FG, Arnone GB, Ravera G, et a1. Pancreatic fistula and relative mortality in malignant disease after pancreaticoduodenectomy.Review and statistical meta-analysis regarding 15 years of literature [J]. Anticancer Res, 1991, 11(5):1831-1848.
10. Grace PA, Pitt HA, Tompkins RK, et a1. Decreased morbidity and mortality after pancreaticoduodenectomy [J]. Am J Surg,1986, 151(1):141- 149.
11. Marcus SG, Cohen H, Ranson JH. Optimal management of the pancreatic remnant after pancreaticoduodenectomy [J]. Ann Surg, 1995, 221(6): 635-645..
12. Sikora SS, Posner MC. Management of the pancreatic stump following pancreaticoduodenectomy [J]. Br J Surg, 1995, 82(12): 1590-1597.
13. Hwang TL, Jan YY, Chen MF. Secural pancreaticojejunal anastomosis for the pancreaticoduodenectomy [J]. Hepatogastroenterology,1996, 43(7): 275-277..
14. Hamanaka Y, Nishihara K, Hamasaki T, et a1. Pancreatic juice output after pancreatoduodenectomy in relation to pancreatic consistency,duct size,and leakage [J]. Surgery, 1996, 119(3):281-287..
15. Iannitti DA, Coburn NG, Somberg J, et a1. Use of the round ligament of the liver to decrease pancreatic fistulas:a novel technique [J]. J Am Coll Surg, 2006, 203(6):857-864.
16. Kapoor VK, Sharma A, Behari A, et a1. Omental flaps in pancreaticoduodenectomy [J]. JOP, 2006, 7(6):608- 615.
17. Maeda A, Ebata T, Kanemoto H, et a1. Omental flap in pancreaticoduodenectomyfor protection of splanchnic vessels [J].World J Surg, 2005, 29(9):1122-1126.
18. 彭淑牖, 劉潁斌, 牟一平, 等. 捆綁式胰腸吻合術(shù)—— 150 例的臨床應(yīng)用 [J]. 中華醫(yī)學(xué)雜志, 2002,82(6): 368-370.
19. 彭淑牖, 劉穎斌, 牟一平, 等. 捆綁式胰腸吻合術(shù)100例報(bào)告[J]. 胰腺病學(xué)雜志, 2001, 1(1):43-45.
20. 彭淑牖, 牟一平, 蔡秀軍, 等. 捆綁式胰腸吻合術(shù)51 例報(bào)告[J]. 外科理論與實(shí)踐, l998, 3(2): 117-118.
21. 彭淑牖, 吳育連, 彭承宏, 等. 一種確保不發(fā)生胰瘺的術(shù)式——捆綁式胰腸吻合術(shù) [J]. 普外基礎(chǔ)與臨床雜志, 1997, 4(4):242-243.
22. Hall RI, Rhodes M, Isabel-Martinez L, et a1. Pancreatic exocrine function after a sutureless pancreaticojejunostomy following pancreaticoduodenectomy [J]. Br J Surg, 1990, 77(1): 83-85.
23. Takao S, Shimazu H, Maenohara S, et al. Modified pancreaticogastrostomy following pancreaticoduodenectomy [J]. Am J Surg, 1993, 165(3):317-321.
24. Berenstern A, Hishima G. Clinical versus experimental use of isobutyl-2-Cyanoacrylate [J]. J Neurosurg, 1987, 67(2):318-320.
25. Vinters HV, Galil KA, Lundie MJ, et a1. The hisotoxicity of cyanoacrylates: a selective review [J]. Neuroradiology, 1985,27(4):279-291.
26. Okamoto A, Tsuruta K. Fistulation method:simple and safe pancreaticojejunostomy after pancreatoduodenectomy [J]. Surgery,2000, 127(4):433-438..
  1. 1. Yeo CJ, Cameron JL, Sohn TA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s:pathology, complications,and outcomes [J]. Ann Surg, 1997, 226(3):248-257.
  2. 2. Yeo CJ, Cameron JL, Maher MM, et a1. A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy [J]. Ann Surg, 1995,222(4): 580-588..
  3. 3. Staley CA, Lee JE, Cleary KR, et a1. Preoperative chemoradiation,pancreaticoduodenectomy,and intraoperative radiation therapy for adenocarcinoma of the pancreatic head [J]. Am J Surg, 1996, 171(1): 118-124..
  4. 4. Matsumoto Y, Fujii H, Miura K, et a1. Successful pancreatojejunal anastomosis for pancreatoduodenectomy [J]. Surg Gynecol Obstet, 1992, 175(6): 555-562..
  5. 5. Cameron JL, Pitt HA, Yeo CJ, et a1. One hundred and fortyfive consecutive pancreaticoduodenectomies without mortality [J]. Ann Surg, 1993, 217(5): 430-435.
  6. 6. 李海民, 竇科蜂, 宋振順, 等. 套人式雙層連續(xù)縫合加捆綁在胰腸吻合術(shù)中的應(yīng)用 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007,14(4): 480..
  7. 7. 彭淑牖, 吳育連, 彭承宏, 等. 捆綁式胰腸吻合術(shù)( 附28 例報(bào)告) [J]. 中華外科雜志, 1997, 35(3):158-159..
  8. 8. 張春秋, 王國華, 彭曉暉, 等. 捆綁式胰腸吻合術(shù)在預(yù)防胰十二指腸切除術(shù)后胰瘺發(fā)生中的臨床應(yīng)用 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008, 15(8): 565-566..
  9. 9. Bartoli FG, Arnone GB, Ravera G, et a1. Pancreatic fistula and relative mortality in malignant disease after pancreaticoduodenectomy.Review and statistical meta-analysis regarding 15 years of literature [J]. Anticancer Res, 1991, 11(5):1831-1848.
  10. 10. Grace PA, Pitt HA, Tompkins RK, et a1. Decreased morbidity and mortality after pancreaticoduodenectomy [J]. Am J Surg,1986, 151(1):141- 149.
  11. 11. Marcus SG, Cohen H, Ranson JH. Optimal management of the pancreatic remnant after pancreaticoduodenectomy [J]. Ann Surg, 1995, 221(6): 635-645..
  12. 12. Sikora SS, Posner MC. Management of the pancreatic stump following pancreaticoduodenectomy [J]. Br J Surg, 1995, 82(12): 1590-1597.
  13. 13. Hwang TL, Jan YY, Chen MF. Secural pancreaticojejunal anastomosis for the pancreaticoduodenectomy [J]. Hepatogastroenterology,1996, 43(7): 275-277..
  14. 14. Hamanaka Y, Nishihara K, Hamasaki T, et a1. Pancreatic juice output after pancreatoduodenectomy in relation to pancreatic consistency,duct size,and leakage [J]. Surgery, 1996, 119(3):281-287..
  15. 15. Iannitti DA, Coburn NG, Somberg J, et a1. Use of the round ligament of the liver to decrease pancreatic fistulas:a novel technique [J]. J Am Coll Surg, 2006, 203(6):857-864.
  16. 16. Kapoor VK, Sharma A, Behari A, et a1. Omental flaps in pancreaticoduodenectomy [J]. JOP, 2006, 7(6):608- 615.
  17. 17. Maeda A, Ebata T, Kanemoto H, et a1. Omental flap in pancreaticoduodenectomyfor protection of splanchnic vessels [J].World J Surg, 2005, 29(9):1122-1126.
  18. 18. 彭淑牖, 劉潁斌, 牟一平, 等. 捆綁式胰腸吻合術(shù)—— 150 例的臨床應(yīng)用 [J]. 中華醫(yī)學(xué)雜志, 2002,82(6): 368-370.
  19. 19. 彭淑牖, 劉穎斌, 牟一平, 等. 捆綁式胰腸吻合術(shù)100例報(bào)告[J]. 胰腺病學(xué)雜志, 2001, 1(1):43-45.
  20. 20. 彭淑牖, 牟一平, 蔡秀軍, 等. 捆綁式胰腸吻合術(shù)51 例報(bào)告[J]. 外科理論與實(shí)踐, l998, 3(2): 117-118.
  21. 21. 彭淑牖, 吳育連, 彭承宏, 等. 一種確保不發(fā)生胰瘺的術(shù)式——捆綁式胰腸吻合術(shù) [J]. 普外基礎(chǔ)與臨床雜志, 1997, 4(4):242-243.
  22. 22. Hall RI, Rhodes M, Isabel-Martinez L, et a1. Pancreatic exocrine function after a sutureless pancreaticojejunostomy following pancreaticoduodenectomy [J]. Br J Surg, 1990, 77(1): 83-85.
  23. 23. Takao S, Shimazu H, Maenohara S, et al. Modified pancreaticogastrostomy following pancreaticoduodenectomy [J]. Am J Surg, 1993, 165(3):317-321.
  24. 24. Berenstern A, Hishima G. Clinical versus experimental use of isobutyl-2-Cyanoacrylate [J]. J Neurosurg, 1987, 67(2):318-320.
  25. 25. Vinters HV, Galil KA, Lundie MJ, et a1. The hisotoxicity of cyanoacrylates: a selective review [J]. Neuroradiology, 1985,27(4):279-291.
  26. 26. Okamoto A, Tsuruta K. Fistulation method:simple and safe pancreaticojejunostomy after pancreatoduodenectomy [J]. Surgery,2000, 127(4):433-438..