胰肠吻合效果影响因素的浅析与吻合技术的原则初探
Analysis of influencing factors on surgical outcome and exploration of technical principles during pancreaticojejunostomy
摘要胰肠吻合是胰十二指肠切除和胰腺中段切除后最常用的吻合方法,其具体操作技术变化多样,目前尚无一种方法可完全避免术后胰瘘的发生。近年来,随着外科理念、手术技术和高科技材料及器械的不断进步,胰瘘发生率有所降低。同时对胰肠吻合效果影响因素的研究亦在逐步深入。作者结合自己多年来实施该手术操作的经验及查阅相关文献,对患者的身体状态和基础条件、胰腺质地和主胰管直径、主要原发病及病程、手术技术、围手术期管理等影响胰肠吻合效果的因素进行了分析,并总结概括了张力适度、保护血运、胰腺断面封闭、胰管和肠黏膜精准对合、个体化、重视学习和经验积累等6条胰肠吻合的手术技术原则,供同道参考。
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abstractsPancreaticojejunostomy is the most common anastomosis following pancreaticoduodenectomy and middle pancreatectomy. The detailed surgical technics of pancreaticojejunostomy vary dramatically, but none of them can achieve zero fistula rate. In recent years,with the development of new surgical concept,application of new surgical technology, high-tech materials and instruments,the incidence of pancreatic fistula has decreased. At the same time,researches on investigating the risk factors of pancreaticojejunostomy are gradually deepening. Based on years of surgical experience on pancreaticojejunostomy and current literatures, this paper analyzes the factors affecting the effect of pancreaticojejunostomy, such as the patient′s basic physical state,pancreatic texture and diameter of the pancreatic duct,pathology and course of the disease,surgical technology and perioperative management,and summarizes six technical principles for pancreaticojejunostomy to be shared with surgical comrades:appropriate tension,protection of blood supply,hermetic closure of pancreatic section,accurate connection of pancreatic duct and intestinal mucosa,individualization,learning and accumulation of experience.
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