The Impact Of Pancreaticoduodenectomy Of Pancreatic Duct Jejunum Anastomosis On Postoperative Pancreatic Fistula Rate

Objective:To analyze the risk factors of pancreatic fistula and pancreatic anastomosis way the incidence of pancreatic fistula based on literature and clinical data of hospital patients after pancreatoduodenectomy .Methods:Collected the data of 45 patients have underdone pancreatoduodenectomy in Fourth Hospital of Hebei Medical University from 1,January,2008 to December,31,2010. The operation performed consisted 44 standard pancreaticoduodenectomy (SPD) and 1 pylorus preserving pancreaticoduodenectomy (PPPD).The order of the digestive tract reconstruction is pancreaticojejunostomy, cholangioenterostomy, gastrointestinal anastomosis of the Child Method. The way of pancreatic duct jejunum is end to side anastomosis of jejunum in operation. Anastomosis: Make a row of interrupted sutures between posterior margin of pancreatic stump and jejunal serosa and muscle layer , then ligation and fixed wall. Poke a small hole which is the same size as pancreatic duct in the empty wall. Suture with absorbable suture between pancreatic duct and empty full-thickness intestinal wall after disinfected,stanched bleeding., temporarily ligated. Insert the drainage tube into pancreatic duct 2~3cm,then fixed in pancreatic tissue.Insert the drainage tube into intestine. Suture ligation between pancreatic duct and empty wall one by one. Finally,interrupted suture between anterior pancreatic stump and Jejunal serosa and muscle layer. That pancreatic drainage tube into the jejunum only is named internal drainage. That drainage out of the body by the intestinal perforation is called the external drainage. Install drainage tube which in jejunum to the place that is near by biliary-enteric anastomosis. At the same time built a T tube in the bile duct.That can drainage pancreatic juice and bile at same time. This study included 24 internal drainage (53.3%), 21 external drainage (46.6%). Finally,insert drainage tube in the upper and lower of jejunum anastomotic.Results:In 45 patients,no deaths,1 case of postoperative pancreatic fistula (2.2%). In 5~40 days after operation ,peritoneal drainage tube drainage of fluid drained about 100ml of white turbid daily. Detection of amylase 3 times higher than normal every three days. in 33 day after operation got high fever, analysis of fever caused by pancreatic fistula after ruled out abdominal infection factors by Bacterial culture of abdominal fluid drainage investigation. Drainage fluid amylase rebacked normal after Acid suppression, inhibiting enzymes, antibiotics, nutritional support and unobstructed drainage.Then, Pull out the abdominal drainage tube and discharged.Conclusion:The retrospective study of 45 patients by pancreatoduodenectomy cases of intraoperative pancreatic duct jejunum anastomosis, 1 case of postoperative pancreatic fistula, the occurrence rate was 2.2%, at a low level. Confirmed that this repair is a simple and practical method. This repair exist of the following advantages:â‘ simple operation, operation time, pancreaticojejunostomy can be completed in only 10 to 15 minutes.â‘¡Pancreatic juice or both, including most of the drainage of bile can be drainaged out of the body, reduce the pressure inside the intestine and is activated when trypsin digestion anastomosis corrosion.â‘¢Pancreatic stump is not exposed to the intestine, no trypsin digestion on the role of pancreatic anastomosis, thereby reducing the incidence of pancreatic fistula.There are a lot of pancreaticojejunostomy ways, but there is no ideal, safe way to totally eliminate the incidence of pancreatic fistula so far. Each method has its own advantages consistent, also has its shortcomings of the Department. Continue to improve the way pancreaticojejunostomy aim is to make as much as possible pancreatic anastomotic blood supply have a good, close, strong, tension, and thus reduce the occurrence of pancreatic anastomotic leakage rate. The consistent approach be adopted with the technique of pancreatic stump mainly those directly related to the experience and habits. No generally accepted method be proofed best one currently.