| Objective: Pancreaticoduodenectomy, mainly applied for treating cancerof Vater ampulla and the head of pancreas, is a highly complex surgicalprocedure with high risk. Pancreatic leakage has become one of the mostsignificant post-operation complications since surgical techniques forreconstructing the pancreatic remnant were used in this procedure.There aretwo kinds of pancreatic leakage, including leakage of the pancreatojejuno-stomy and leakage of pure pancreatic juice. The leakage ofthe pancreatojejunostomy, which is connected with techniques and methods ofthe anastomosis, is the digesting juice in intestinal intruding in abdominalcavity through the weakness of the anatomosis. Because the pancreaticenzymes can be activated by the digesting juice, this kind of pancreaticleakage can lead to severe complications with devastating effects,such asbleeding in abdominal cavity and infection.The other is the leakage of purepancreatic juice, which is often caused by the injury of the capillary pancreaticduct when sutureing. This kind of leakage can be healed itself without treatingbecause the pancreatic enzymes have not been activated.Child,whipple et.putup that the key point of pancreaticoduodenectomy was pancreatojejunostomya long time ago.The leakage of pancreatojejunostomy is the main cause of thepost-operation deat. In order to decrese the rate of pancreatic leakage, manyresearches and improvements have been made.So far, more than50methodsfor pancreatojejunostomy have been reported. But the pancreatic leakage stillhappened in some large medical center for pancreatic cancer. According to thereports, the rate of pancreatic leakage is6%-24%and the mortality is nearly40%high. Exploring proper and efficient methods of pancreatojejunostomy to decrease the pancreatic leakage rate has become the focus for many years inthe area of pancreatic surgery research all over the world. In this study, twomethods of pancreatojejunostomy were discussed in order to find out a bettermethod both for the patients and the development of the department.Method:95patients without severe disease, who were admitted in ourdepartment and had pancreatoduodenectomy between Jan,2012to Jan,2013,were involved in this study. The95patients were divided into two groupsaccording to the types of anastomosis, including65patients in the traditionalgroup (end-to-end pancreatojejunostomy with invagination) and30in themodified group(end-to-side pancreatojejunostomy without invagination andexternal drainage of the pancreatic duct). There were33male and32femaleswith the average age of55.61±9.96years old(29-75) in the traditional group.There were18male and12females with the average age of60.93±10.42yearsold(39-76) in the traditional group.Progressive jaundice and abdominal painwere the main complaints. There were71cases with progressivejaundice(74.73%),49cases with abdominal pain(51.58%), and25cases withboth syndrome(26.32%).All the diagnosis were surpported by the pathologicalresults, including31cases with cancer of pancreatic head,7cases with cancerof Vater ampulla,22cases with cancer of the common bile duct cancer,24cases with cancer of major duodenal papilla, and11cases with other kind ofcancer.The hospitalization time after operation, the time when the drainagetube was removed, the complications, the expense for hospitalization,labarotory results of post-operative alkaline, bilirubin, and total bile acid andother index were statistically analyzed to evaluate the types ofpancreatojejunostomy inorder to figure out the better procedure for thepatients. Also，single factor logistic regression analysis was used to analyzerelated factors to pancreatic leakage in order to decrease the rate ofpost-operation pancreatic leakage.Result: For the pre-operation conditions, there was no statisticaldifference for the patients’age, gender, the laboratory results includinghemoglobin, albumin, total bilirubin, alkalin phosphatase, alkalin transferase, total bile acid between traditional group and modified group(P>0.05). For theintraoperative conditions, the two kinds of procedures were comparable for allthe operations were completed by the same team of surgeons.The operatingtime of modified group（407.31±68.94minutes）was45.64minutes shorter inaverage than that of traditional group（361.67±45.92minutes). There was asignificant difference in operating time between the two groups(P=0.023，t=3.299).The intraoperation average blood loss(668.33±448.46mL)andtransfusion blood volume(851.67±570.31mL)of modified group were less thanaverage blood loss(950±1026.71mL)and transfusion blood volume（1161.92±1277.49mL）of traditional group respectively, but there was nosignificant difference between the two groups. For post-operation conditions,the rate of complications in modified group(20.00%) was less than that oftraditional group(29.47%), especially for the pancreatic leakage(3.33%inmodified group and13.68%in traditional group). There was a significantdifference between the two groups. The rates of bile leakage and delayedgastric emptying and mortality in modified group were lower than those oftraditional group, but there was no significant difference between the twogroups. The expense for hospitalization in modified group was0.71*104yuanless than that of traditional group, but there was no significant differencebetween the two groups. The admitted days of modified group were1.12days fewer than that of traditional group, but there was no significantdifference between the two groups. There was no significant difference in labresults(TBil, TBA, ALP,et.) between the two groups. The time when thedrainage tube was removed of modified group was earlier than that oftraditional group, but there was no significant difference between the twogroups. The pre-operation level of billirubin and the pancreatic texture weretwo related risk factors to post-operation pancreatic leakage.Conclusion: It is suggested that the modified procedure of end-to-sidewith external drainage of the pancreatic duct is more convenient and efficientto operate and can lead to a better recovery, shorter hospitalization, lowermortality and fewer complications for the patients when compared with the traditional procedure of end-to-end pancreatojejunostomy with invaginationaccording to this study. The modified procedure of end-to-side pancreatoje-junostomy with external drainage of the pancreatic duct can decrease to rate ofpost-operation pancreatic leakage. It is a safe, reliable, rational and feasibleprocedure for pancreatojejunostomy.The study of pancreatic leakage throughsingle factor Logistic regression analysis shows that preoperative andintraoperative pancreatic bilirubin level texture is two riskfactors ofpostoperative pancreatic leakage. So we can reduce the risk factors ofpancreatic leakage and to reduce the occurrence of pancreatic leakage rate of. |
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