The Comparative Study Of The Totallyone-layer And Stratified Pancreaticojejunostomy In Pancreaticoduodenectomy

Objectives: Toexplore the clinical effect of totally one-layer End-to-Side Pancreaticojejunostomy in Pancreaticoduodenectomy.Methods: In this retrospective observational study,the clinical data of 79 patients who received pancreaticoduodenectomy from January 2015 to February 2017 at the Department of Basic Surgery,Union Hospital of Fujian Medical University were collected,which included 43 patients in the observation group who underwent totally one-layer end-to-side pancreaticojejunostomy,the control group of 36 cases,who underwent stratified Pancreaticojejunostomy.This study countsthe time of anastomosis,bleeding volume,postoperative hospital stay and postoperative complications.The postoperative complications include pancreatic fistula,abdominal infection,abdominal bleeding,pulmonary infection,delayed gastric emptying and death.Results:The mean pancreatic anastomosis time in the totally one-layer end-to-side pancreaticojejunostomywas significantly shorter in the stratified Pancreaticojejunostomy(26.65 ± 1.84 vs 34.47 ± 2.29,P <0.05)min.The mean intraoperative blood loss(ml)was not statistically significant in the two groups(457.67 ± 326.28 vs 494.44 ± 551.07,P> 0.05).In addition,the mean postoperative hospital stay(d)was not statistically significant between the two groups(19.93 ± 8.29 vs 22.28 ± 13.46,P> 0.05).There were no deaths in 79 patients,and there was no significant difference in the incidence of postoperative complications between the two groups(P> 0.05).Among them,there were 8 cases of postoperative pancreatic fistula(Pancreatic fistula),the total incidence of PF was 10.1%.Theincidence of pancreatic fistulain the totally one-layerend-to-side pancreaticojejunostomy was 7.0%(3/43),which was 13.8%(5/36)in the stratified Pancreaticojejunostomy.The total incidence of abdominal infection was13.9%(11/79),which was 9.3%(4/43)in the observation group and 19.4%(7/36)in the control group.The total incidence ofpulmonary infection was 18.9%,which was 14.0%(6/43)in the observation group and 25.0%(9/36)in the control group.The total incidence of gastric emptying was 3.80%.There were 2 cases(4.7%)in the observation group and 1 case(2.8%)in the control group.Postoperative pathological examination of the 79 pantients showed 27 cases of pancreatic carcinoma,14 ofampullary malignant tumor,7 of duodenal malignant tumor,3 of bile duct carcinoma,28 of other diseases which including benign tumor,chronic pancreatitis,28 cases.Conclusions:according to the limited data of this study,the totally one-layerend-to-side pancreaticojejunostomyis asimple,convenient and safeway of pancreatic anastomosis.It is worthy of clinical promotion.