| Pancreatic leakage is the most dangerous complication after pancreatoduodenectomy. The morbidity varies from 8% to 19% and the mortality varies from 20% to 40%. Prevention of pancreatic leakage is the key to performing pancreatoduodenectomy.When the pressure is higher than the tolerance of the pancreatojejunostomy, the pancreatic juice will come out from the anastomose. This may be the basic mechanism of pancreatic leakage. Professor Peng designed a special procedure, named binding pancreatojejunostomy (BPJ), and had reported 150 cases without leakage. It will be helpful for popularization and modifying of the BPJ if we can evaluation the superiority of the BPJ and the optimal degree of binding from the point of view of the tolerance pressure of the pancreatojejunostomy.In order to validate the significance of the binding in the BPJ and investigate the reasons of the variation of pre-binding tolerance pressure of the pancreatojejunostomyin the different kinds of cases, we analyzed the changing of pre-binding and post-binding tolerance pressure of BPJ and the variation of the pre-binding pancreatojejunostomy tolerance pressure in different cases.Material and MethodWe measured the pre-binding and post- binding tolerance pressure of the pancreatojejunostomy in 24 patients who had been performed BPJ by one attending surgeon at the Department of General Surgery of Sir Run Run Show Hospital from Jan 2002 to April 2003.ResultsIn these 24 patients, 1 Teases were male and 7 cases were female, and the ratio of male to female was 2.4 : 1. The age varied from 34 to 73 years old , with the average of 56.8. 11 patients had epigastric pain (45.8%), 16 patients had obstructive jaundice (26%) and 13 patients had the dilation of the pancreatic duct (54.2%). 21 patients received pancreatoduodenectomy (87.5%), 2 patients received pylorus preserved pancreatoduodenectomy(8.3%) and 1 patient received partial pancreatic resection and pancreatojejunostomy(4.2%). The pancreatic consistency was normal in 10 cases (41.7%) and hard in other 14 patients (58.3%). The average operation time is 6 hours. The average blood loss was 720 ml and 7 patients received transfusion during peri-operation.The pathologic diagnosis was 4 cases of well differentiation pancreatic carcinoma, 3 cases of middle differentiation pancreatic carcinoma, 2 cases of poor differentiation pancreatic carcinoma, 1 case of pancreatic cyst, 1 case of chronic pancreatitis, 2 cases of well differentiation peri-ampullary carcinoma , 6 cases of middle differentiation peri-ampullary carcinoma, 1 case of papillary carcinoma, 1 case of villous carcinoma, 1 case of anaplastic carcinoma , 1 case of benign duodenal stroma, and 1 case of malignance duodenal stroma .There were no pancreatic leakage and no death. The mean hospital stay after operation was 18.5 days (median, 16 days; range 10-60 days). There were 8 patients with complications(33.3%).The pre-binding tolerance pressure of the pancreatojejunostomy varied from 28 cmH2O to 65 cmH2O, with the average of 45.91 cmH2O. The post-binding tolerance pressure of the pancreatojejunostomy was more than 85.2 cmH2O. It was obviously higher than pre- binding (P<0.01) . The mean pre-binding tolerance pressures of the patients with the dilated pancreatic bile duct or not were 50.2cmH2O and 38.2cmH2O respectively. The former was obviously higher than the latter (P<0.01) . And the mean pre-binding tolerance pressures of the patients with hard or normal pancreas were 50.4cmH2O and 40.6cmH2O respectively. The former was obviously higher than the latter (P0.05). Other factors such as age, gender, obstructive jaundice and the location of the lesions had no impact on the the pre-binding tolerance pressure of the pancreatojejunostomy (P>0.05) .Conclusion1. For BPJ, binding can obviously increases the tolerance pressure of the pancreatojejunostomy . So it makes the pancreatojejunostomy safer.2. The degree of binding enacted in our study is suitable.3. No dilation of pancreatic duct a...
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