中国实用外科杂志

中国实用外科杂志

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胰胃吻合术治疗胰十二指肠切除术后胰肠吻合口狭窄3例疗效分析

王许安1 ，蔡炜龙2，翁    昊1，吴文广1，周学平1 ，陈立天1 ，龚    伟1，王    平3，王雪峰1，刘颖斌1，彭淑牖4   

  1. 1上海交通大学医学院附属新华医院普外科，上海200092； 2湖州市中心医院普外科，浙江湖州313003；3浙江大学医学院附属杭州市第一人民医院普外科，浙江杭州310006；4浙江大学医学院附属第二医院普外科，浙江杭州  310009
  • 出版日期:2019-10-01 发布日期:2019-10-10

  • Online:2019-10-01 Published:2019-10-10

摘要：

目的    观察胰胃吻合术治疗胰十二指肠切除术后胰肠吻合口狭窄的临床疗效。方法    回顾性分析2010年5月至2017年12月收治的3例内镜治疗失败的胰十二指肠切除术后胰肠吻合口狭窄病人的临床资料。通过开腹探查、切除胰肠吻合口，采用单层捆绑式胰管胃黏膜吻合术进行残胰消化道重建。观察术中和术后情况。结果    从胰肠吻合至诊断胰肠吻合口狭窄的时间分别为72、37 和21个月。3例病人手术均顺利完成，手术时间为137、210、120 min，出血量为 210、350、180 mL。术后未出现胰瘘、出血、感染等并发症。术后症状缓解，术后随访23、58和15个月未再发作。结论    对于内镜治疗失败的胰十二指肠切除术后胰肠吻合口狭窄病人，胰胃吻合术特别是单层捆绑式胰管胃黏膜吻合术是可考虑采取的手术方案。

关键词: 胰十二指肠切除术, 胰肠吻合口狭窄, 单层捆绑式胰管胃黏膜吻合, 内镜逆行胰管造影

Abstract:

Pancreaticogastrostomy for the treatment of pancreatojejunostomy stricture after pancreaticoduodenectomy：A report of 3 cases        WANG Xu-an*，CAI Wei-long，WENG Hao，et al. *Department of General Surgery，Xinhua Hospital，Shanghai Jiaotong University School of Medicine，Shanghai 200092，China
Corresponding author：LIU Ying-bin ，E-mail: laoniulyb@163.com
Abstract    Objective    To investigate the clinical value of pancreaticogastrostomy (PG) in the treatment of pancreatojejunostomy stricture (PJS) after pancreaticoduodenectomy (PD). Methods    The clinical data of 3 patients with PJS who failed the endoscopic treatment underwent PG followed by resection of pancreatojejunostomy (PJ) from May 2010 to December 2017 in Department of General Surgery，Xinhua Hospital，Shanghai Jiaotong University School of Medicine were analyzed retrospectively. After the pancreatointestinal anastomosis was explored and resected, the digestive tract of the remnant pancreas was reconstructed by using the single-layer bundle pancreaticogastric mucosa anastomosis. The intraoperative and postoperative conditions were observed. Results    The median time of presentation was 72，37 and 21 months. Three cases of operation were completed successfully. The operation time was 137, 210, 120 min，and blood loss was 210, 350, 180 mL. No pancreatic fistula，surgical bleeding and other serve complication occurred postoperatively. All the 3 patients experienced resolution of symptoms without recurrent acute pancreatitis after PG during the follow-up of 23, 58 and 15 months. Conclusion    PG especially duct-to-mucosa PG followed by resection of PJ could be used in the PJS patients who failed the endoscopic treatment.

Key words: pancreaticoduodenectomy, pancreatojejunostomy stricture, single-layer bundle pancreaticogastric mucosa anastomosis, endoscopic retrograde pancreatography