Stenting Is Unnecessary in Duct-to-Mucosa Pancreaticojejunostomy Even in the Normal Pancreas
Stenting Is Unnecessary in Duct-to-Mucosa Pancreaticojejunostomy Even in the Normal Pancreas
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DOI：
10.1159/000055901
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发表时间：
2002-04
期刊：
影响因子：
3.6
通讯作者：
T. Imaizumi;N. Harada;T. Hatori;A. Fukuda;K. Takasaki
中科院分区：
文献类型：
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作者：
T. Imaizumi;N. Harada;T. Hatori;A. Fukuda;K. Takasaki
背景资料：由于胰腺外分泌功能良好，胰管切除术（PD）后行胰肠吻合术后发生吻合口瘘的风险较高。因此，这些PD通常使用支架管（支架法）进行。近年来，我们施行胰管空肠吻合术，采用无支架管（无支架法）的胰管-粘膜吻合术，取得了良好的效果。研究方法：该技术的要点是通过用细的无创针和单丝小心地拾取胰管壁来保持胰管的充分通畅。对109例正常胰腺行胰管空肠端侧吻合术，比较无支架组与支架组的吻合效果。结果：各组之间的背景特征（包括年龄、性别和疾病）没有差异。非支架组完成胰肠吻合的平均时间为26.6分钟，支架组为29.2分钟。各组的平均手术持续时间和术中失血量也相似。术后早期并发症导致的死亡率分别为20.2%和23.1%，分别有7.3%和7.7%的患者发生胰漏。这些差异无统计学显著性。支架组1例患者在胰肠吻合口渗漏后死于败血症。开始固体食物摄入或术后住院时间的平均时间也无显著差异。结论：我们的结论是，支架管是不必要的，如果管道粘膜吻合完全执行。由于风险低，这种手术技术可以被认为是胰肠吻合术的基本操作。
Background: There is a high risk of anastomotic leakage after pancreaticojejunostomy after pancreaticoduodenectomy (PD) in patients with a normal pancreas because of the high degree of exocrine function. These PD are therefore generally performed using a stenting tube (stented method). In recent years, we have performed pancreaticojejunostomy with duct-to-mucosa anastomosis without a stenting tube (nonstented method) and obtained good results. Methods: The point of this technique is to preserve adequate patency of the pancreatic duct by carefully picking up the pancreatic duct wall with a fine atraumatic needle and monofilament thread. The results of end-to-side pancreaticojejunostomy of the normal pancreas were compared between the nonstented method (n = 109) and the stented method (n = 39). Results: There were no differences in background characteristics between the groups, including age, gender and disease. The mean duration to complete pancreaticojejunostomy was 26.6 min in the nonstented group and 29.2 min in the stented group. The mean durations of surgical procedure and intraoperative blood loss were also similar in the groups. Morbidity rates due to early postoperative complications were 20.2 and 23.1%, with pancreatic leakage occurring in 7.3 and 7.7% of patients, respectively. These differences were not statistically significant. One patient in the stented group died of sepsis following leakage of pancreaticojejunostomy. There were also no significant differences in the mean time to initiation of solid food intake or postoperative hospital stay. Conclusion: We conclude that a stenting tube is unnecessary if the duct-to-mucosa anastomosis is completely performed. This operative technique can be considered a basic procedure for pancreaticojejunostomy because of the low risk.