Comparison Of Clinic Effect Between Binding Pancreaticogastrostomy And Binding Pancreaticojejunostomy In Pancreaticoduodenectomy

Objective:To discuss clinic effect and possibly superiority of binding pancreaticogastrostomy in pancreaticoduodenectomy according to prospective randomized double-blind study of binding pancreaticogastrostomy and binding pancreaticojejunostomy.Methods:Study 25 patients who underwent pancreaticoduodenectomy in one medical team of general surgery department in Sir Run Run Shaw Hospital from November 2009 to March 2011. These patients routine to take the principle of double-blind randomized controlled bundled into binding pancreaticojejunostomy(10) and binding pancreaticogastrostomy(15) groups. Comparison of rate and mortality of perioperative complications such as postoperative pancreatic fistula, biliary fistula, hemorrhage, and delayed gastric emptying, etc. And we also record time of tube removal, consuming semi-liquid food, postoperative hospital stay and other recovery indicators.Results:BPG group had 15 patients,6 patients had complications (40%), of which 2 cases of pancreatic fistula, biliary fistula in 2 cases,1 case of postoperative hemorrhage,1 case of delayed gastric emptying; BPJ group had 10 patients,5 cases had complications (50%). Pancreatic fistula occurred in 3 cases, of which 1 case combining biliary fistula, and 1 combining delayed gastric emptying, gastric ulcer hemorrhage after surgery in 2 cases. The complications of two groups were not significant results (P> 0.05). Two groups of patients had no reoperations, no patients died. BPG group, the average time of pancreatic anastomosis (35.3±10.2) min, BPJ groups (50.5±20.0) min, and the difference was statistically significant (P<0.05). BPG group and BPJ group, operating time were (286.9±56.9) min and (297±50.8) min, blood loss were (706.7±361.5) ml and (640±183.8) ml, there were no significant differences. Average time of consuming semi-liquid food of BPG group was (9.3±2.3)d and BPJ group (13.8±5.3)d, with statistically difference (P<0.05). Anal exhaust time of BPG group and BPJ group were (5.1±1.2) d and (5.6±1.1) d, pull tube time (6.4±1.6) d and (7.6±2.6) d, postoperative hospital stay (17.8±4.0) d and (20.8±10.2) d, there were also no significant difference.Conclusions:Binding pancreaticogastrostomy is a safe and effective reconstruction of pancreatic digestive tract as binding pancreaticojejunostomy. Binding pancreaticogastrostomy is relatively simple, and may have clinical advantages in the prevention of postoperative pancreatic fistula and postoperative hemorrhage, but it still need large prospective randomized controlled study to confirm.