胰腺肿瘤或胆管癌行胰十二指肠切除后胰肠吻合口漏是术后最常见的并发症，也是导致患者术后感染出血甚至死亡的最主要的原因。最新一期美国外科杂志Journal of investigative surgery发表了山东大学齐鲁医院普外科李涛副主任医师的文章。该文章介绍了一种简单安全的胰肠吻合术式--胰腺空肠套入U型交锁缝合技术。该技术可显著简化胰肠吻合的步骤，减少吻合时间，最重要的是可显著降低胰肠吻合口漏及感染出血的发生率，降低患者的并发症及死亡率，缩短住院时间及住院花费, 具有十分重要的临床意义。
J Invest Surg. 2014 Dec 1. [Epub ahead of print]
Li T1, Luo LX, Zhang C, Wang GP, Chen ZT, Jiang ZC, Wang XY, Zhi XT.
ABSTRACT Background: Postoperative pancreatic fistula associated with mortality and morbidity remains an intractable problem after pancreaticoduodenectomy. To date it still carries a notable incidence of roughly 10% to 30% in large series in spite of numerous pharmacological and technical methods that have been proposed to achieve a leakproof pancreatic remnant. Methods: In order to perform a safe anastomosis to pancreatic remnant with less sophisticated sutures and shorter operative duration, a fast and simple technique of end-to-end invaginated pancreaticojejunostomy with three overlapping U-sutures was devised in our institution. Results: Between April 2011 and July 2013, end-to-end invaginated pancreaticojejunostomy with three overlapping U-sutures technique was used in 23 consecutive cases that underwent pancreaticoduodenectomy in our institute. The median operative time for pancreaticojejunostomy was 12 min. The incidence of pancreatic fistula was 8.7% (n = 2) and both cases were grade A fistula with no clinical impact or delayed hospital discharge. Neither relaparotomy nor postoperative mortality was observed. Conclusions: The technique of using three overlapping U-sutures in an end-to-end invaginated pancreaticojejunostomy represents a simple management of pancreaticoenteric anastomosis with reliability and applicability, and provides an alternative choice for pancreaticojejunostomy to senior pancreatic surgeons as well as those without experience.
pancreatic fistula; pancreaticoduodenectomy; pancreaticojejunostomy