The Effect Of Pancreaticojej Unostomy On Pancreatic Fistulas In Pancreatoduodenectomy

Objective:In pancreatoduodenectomy,the occurrence of pancreatic fistulas was used as an evaluation index to compare the occurrence of pancreatic fistulas under different anastomoses and to evaluate the best anastomosis in pancreaticoduodenal surgery.Methods:A retrospective analysis of patients undergoing pancreatoduodenectomy performed by the Hepatobiliary and Extrapancreatic Surgery team of Ganmei Hospital(the First People's Hospital of Kunming)from 2006 to 2017 was performed in a total of 130 patients.1.According to the anastomosis was divided into group A(tissue to mucosa anastomosis),B group(duct to mucosa anastomosis),preliminary comparison of two anastomosis methods of pancreatic fistulas occurred.2.Considering the influence of the pancreatic duct diameter,the pancreatic duct dilatation is divided into the C group(pancreatic duct does not dilate the duct to mucosa anastomosis)and the D group(pancreatic duct does not dilate pancreatic tissue to mucosa anastomosis).E group(pancreatic duct dilation for pancreatic duct to mucosa anastomosis),and F group(pancreatic duct dilatation for pancreatic duct to mucosa anastomosis).In order to compare the pgancreatic duct expansion or not for the use of different anastomosis type of pancreatic fistulas occurred.3.The use of pancreatic duct to mucosa anastomosis continued to be discussed,divided into G group(pancreatic duct expansion without continuous anastomosis),H group(pancreatic duct expansion without intermittent anastomosis),I group(pancreatic duct expansion continuous anastomosis)In group J(pancreatic duct dilatation and intermittent anastomosis),the effect of continuous anastomosis or intermittent anastomosis on the occurrence of pancreatic fistulas in pancreatic duct to mucosa anastomosis was explored.The evaluation criteria for pancreatic fistulas was based on the International Pancreatic Surgery Group's postoperative pancreatic fistulas definition and grading system(2016 version),which was divided into A,B,and C grades,in which grade C was defined as severe pancreatic fistulas.Statistical analysis of the measurement data using T test,count data using chi-square test.Results:1.The incidence of pancreatic fistulas and the incidence of severe pancreatic leakage were lower in group B than in group A.2.The incidence of pancreatic fistulas and the incidence of severe pancreatic fistulas were lower in group C than in group D;the incidence of pancreatic fistulas and the incidence of severe pancreatic fistulas were lower in group E than in group F.3.The incidence of pancreatic fistulas in group H was lower than that in group G;the incidence of pancreatic fistulas in group I was lower than that in group J.Conclrusion:1.For pancreatoduodenectomy,the occurrence of pancreatic fistulas as an evaluation index,preliminary discussion The use of pancreatic ducts for jejunal mucosal anastomosis is superior to pancreatic jejunal mucosa anastomosis2.Even considering the influence of the diameter of the pancreatic duct,whether the pancreatic duct is dilated or not,it is still confirmed that the anastomosis of the pancreatic duct to the jejunum mucosa is better than the anastomosis of the tissue to the mucosa.3.In duct to mucosa anastomosis,if the pancreatic duct is dilated,continuous anastomosis is better than intermittent anastomosis;if the pancreatic duct is not dilated,the use of intermittent anastomosis is better than continuous anastomosis.