胰肠套入式吻合胰管内不置引流管在胰十二指肠切除术中的应用分析

黄卫华，陈振伟

（西安高新医院普外科，陕西 西安，710075）

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摘要：

目的 总结在胰十二指肠切除术中胰管内不置引流管胰肠套入式吻合的临床经验。方法 回顾性分析我院收治的18例胰十二指肠切除术患者的临床资料。所有患者均采用Whipple式切除胰十二指肠，消化道采用Child重建，胰肠吻合的具体方法包括残胰断面的处理、胰空肠端端套入式吻合及经T形管行空肠输入袢减压及胆管引流和胆肠吻合，不向主胰管内插硅塑管。强调围手术期处理，术后预防性应用生长抑素，改善微循环，尽早恢复胃肠功能。结果 经手术治疗，所有患者术后均无胰瘘发生，手术时间平均为5.5h，术后患者恢复良好。结论 胰管内不置引流管胰肠套入式吻合应用于胰十二指肠切除术疗效满意，不必将胰管引流导管经肠袢引至体外，操作容易，安全可靠。

关键词：胰十二指肠切除术；胰肠套入式吻合；胰管内不置引流管

中图分类号：R739.4文献标志码：A文章编号：2096-1413(2017)04-0020-00

Application analysis of invaginated pancreaticojejunostomy without pancreatic ductal drainage tube in pancreaticoduodenectomy
HUANG Wei-hua, CHEN Zhen-wei
(Department of General Surgery, Xi'an Gaoxin Hospital, Xi'an 710075, China)

ABSTRACT: Objective To summarize the clinical experience of the application of invaginated pancreaticojejunostomy without pancreatic ductal drainage tube in pancreaticoduodenectomy. Methods The clinical data of 18 patients with pancreaticoduodenectomy admitted in our hospital were retrospectively analyzed. The pancreaticoduodenectomy was performed by Whipple approach, and the digestive tract was reconstructed by Child approach. The specific methods of invaginated pancreaticojejunostomy were the management of remaining pacreas, invaginated pancreaticojejunostomy, jejunum input loops decompression and duct drainage through T tube and biliary -intestinal anastomosis. Non silicone tube was inserted into the main pancreatic duct. The perioperative treatment was strengthened and preventive somatostatin was used after the operation. Otherwise, the microcirculation was improved and the gatric-intestinal function was recovered as soon as possible. Results No pancreatic fistula was found in this study, average operative time was 5.5 hours, and all patients recovery well. Conclusion The outcome of the application of invaginated pancreaticojejunostomy without pancreatic ductal drainage tube in pancreaticoduodenectomy is significant. The approach is simple and safet.
KEYWORDS: pancreaticoduodenectomy; invaginated pancreaticojejunostomy; without pancreatic ductal drainage tube in pancreaticojejunostomy

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