连续缝合在胰肠吻合中的应用.doc

连续缝合法在套入式胰肠吻合中的应用 刘双海 周一夫 汤晓东 陈 胜 薛红娣 周 标 （东南大学医学院附属江阴医院肝胆外科) 【摘要】 目的 探讨在胰十二指肠切除术中利用连续缝合法进行套入式胰肠吻合对预防胰瘘发生的作用。方法通过采用4毋可吸收线连续缝合法对22例胰十二指肠切除患者进行端侧套入式胰肠吻合，并以同期实施的12例端侧套入式间断缝合、23例胰管空肠黏膜吻合术进行比较。结果22例患者均顺利施行套入式连续胰肠吻合，平均时间约13 min，术后l例出现胆漏，未发生胰肠吻合口漏，无手术死亡。患者平均住院15 d。同期端侧套入式间断缝合时间平均20 rain，术后发生胰漏2例，腹腔感染l例，其中1例并发腹腔大出血死亡；端侧胰管空肠黏膜吻合时间平均18 min，发生胰漏l例，上消化道出血l例。术后患者平均住院19 d。结论连续套入式胰肠吻合适用于任何情况下的残余胰腺，且操作简便、省时、并发症少，是胰肠吻合技术的一种有效改进。 【关键词】吻合术，外科；胰十二指肠切除术；缝合技术；胰腺瘘 Continuous suture in invaginated pancreaticoenterostomy LIU Shuang-hai，ZHOU ，TANG Xiao-，CHEN Sheng，XUE Hong-di，ZHOU Biao．Department of Hepatobiliary Surgery,Affiliated JiangYin Hospital,Medical School of Southeast University, JiangYin 214400 Corresponding author：LIU Shuang-halEmail：liushuanghai@medmailcn 【Abstract】 Objective To investigate the preventive effect of postoperative pancreatic leakage by continuous invaginsted pancreaicoenterostomy in pancraticeduodenectomy. Methods Twenty-two pancreaticoduodenectomy procedure were performed by continuous invaginated pancreaticoenterostomy with 4-0 absorbable suture and the results were compared with those of 12 end-to-side invagination interrupted suture procedures and 23 pancreatic duct jejunum anastomosis procedures． Results All continuous invaginaed pancreaticoenterostomy cases were performed successfully with the average time of 13 minutes，and one biliary leak occurred postoperatively；and there was no pancreatic anastomotic leak and no death．The mehospital stay of the patients was 15 days．While the mean time of end-to-side invanation interrupted suture procedures was 20 minutes，one biliary leak and one abdominal infection occurred，and one patient died of abdominal bleeding．The men time of pancreatic duct jejunum anastomosis procedures was 18 minutes，and one panctic leak and one upper gastrointestinal bleeding occurred．The mean postoperative hospital stay of these patients ws 19 days. Condnsions Continuous invaginated pancreaticoenterostomy is appli