Different Pancreaticojejunostomy And Pancreatic Fistula

ObjectiveTo explore the effects of different pancreaticojejunostomy during pancreaticoduodenectomy on preventing pancreatic fistula with the aim to find the optimal kind of pancreaticojejunostomy.MethodsThe clinical data were reviewed, which contained59patients with4kinds of different pancreaticojejunostomy at the Department of Hepatobiliary Surgery of Qilu Hospital from June2009to June2012, to compare their actual clinical effect. The pancreaticojejunostomy anastomosis included end-side duct-mucosa pancreaticojejunostomy, end-end invaginated pancreaticojejunostomy, end-side invaginated pancreaticojejunostomy and binding pancreaticojejunostomy, and the procedure was performed according to the pancreatic stump size, texture of pancreas and pancreatic duct diameter. All the patients were divided into4groups according to the procedure, A group, end-side mucosa-mucosa anastomosis (31cases), B group, end-end invaginated pancreaticojejunostomy (12cases), C group, end-side invaginated pancreaticojejunostomy (7cases), D group, binding pancreaticojejunostomy (9cases). There were35cases of male and24females whose age varied from13to82and the mean age was57. Based on clinical symptoms, biochemical indicators, preoperative imaging diagnosis and pathological diagnosis, the diseases were confirmed. There were32cases of pancreatic head carcinoma,10cases of the common bile duct cancer,9cases of papillary carcinoma,5cases of ampullary cancer,3cases of pancreatic solid pseudopapillary tumor. SPSS17.0was used for analyzing, statistical count data was analyzed by one-way ANOVA analysis and Rank sum test, measurement data by chi-square test.Results①Comparison between each group of patients in preoperative conditions:P (age)=0.578, P (gender)=0.763, P (albumin)=0.642, P (alanine aminotransferase) =0.685, P (total bilirubin)=0.735, all were greater than0.05.②Comparison between each group of patients in operative conditions:P (operation time)=0.032<0.05, P (blood loss)=0.536>0.05. Group A patients cost a longer time which average was5.5±0.6h, comoparing with B, C, and D group, the difference was statistically significant (P<0.05)③Comparison between each group of patients in length of hospital stay:P=0.823>0.05.④Comparison between each group of patients in complications and mortality rates:P (pancreatic fistula rate)=0.600, P (biliary fistula rate)=0.692, P (upper gastrointestinal bleeding rate)=0.843, P (delayed gastric emptying rate)=0.744, P (lung infection)=0.056, P (mortality)=0.821. All were greater than0.05.ConclusionThe incidances of pancreatic fistula between different pancreaticojejunostomy were not different. The operation time of end-side mucosa-mucosa anastomosis was longer than the others. Satisfactory efficacy and low postoperative complications rates can be achieved by any kind of pancreaticojejunostomy depending on the conditions of the pancrease such as the pancreatic stump, size of the pancreatic duct diameter and pancreas texture with proficiency of technique. During the operation, setting drainage tube and carrying gas-filling test to check the anastomosis and placing jejunal feeding tube for enteral nutrition may are all important methods for the prevention of pancreatic fistula.