目的探讨保留幽门胰胃吻合式胰十二指肠切除术的临床应用价值。方法对36例壶腹周围癌患者在证实胃幽门、幽门上、下淋巴结及十二指肠球部未受侵犯的情况下，施行保留幽门胰胃吻合的胰十二指肠切除术，术后观察治疗效果，并进行随访。结果本组无手术死亡、胆胰瘘、出血等并发症发生。5例术后短期内有胃排空延迟症状，经处理后缓解，无吻合口溃疡和胆道返流症状。1、3、5年累计生存率分别为61.1%、25.0%和13.9%。结论本术式可降低胰十二指肠切除术的死亡率和并发症，1、3、5年生存率与Whipple手术相比无差异。
目的 探讨胰十二指肠切除术胰与消化道重建方法的选择。方法 对我院1989～1999年施行的胰十二指肠切除术后胰胃吻合83例行回顾性总结，其中行经典的胰十二指肠切除术76例，保留幽门的胰十二指肠切除术7例。胰胃吻合是残余胰腺与胃后壁间断单层植入式吻合。结果 住院病死率为2.4%（2/83）； 并发症发生率为25.3%（21/83），其中胰瘘3例，胆瘘2例，吻合口出血3例，切口裂开5例，胃排空迟缓5例，腹腔感染1例，胸腔积液1例，肠梗阻1例。结论 胰胃吻合术简便、安全，是降低术后胰瘘的胰肠重建方法。
Objective To explore the risk factors and treatment associated with postoperative hemorrhage after pancreaticoduodenectomy. Methods The clinical data of 78 patients undergoing pancreatieoduodeneetomy from May 2009 to October 2011 were retrospectively analyzed in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. Results The incidence of postoperative hemorrhage was 10.3％ （8/78）. Among these eight patients, intra-abdominal hemorrhage occurred in two cases （one case of early and delayed hemorrhage respectively）, and gastrointestinal hemorrhage occurred in 6 cases （one and five cases of early and delayed hemorrhage respectively）. Univarlate analysis showed that operative blood loss, postoperative celiac infection, pancreatic fistula, and pancreaticogastrostomy were significantly associated with postoperative hemorrhage. Multivariate analysis identified for vailables as independent factors associated with postoperative hemorrhage, namely, pancreaticogastrostomy, postoperative celiac infection, and pancreatic fistula. Conclusions Skillful operation, prevention of pancreatic fistula, and control celiac infection are important for reducing postoperative hemorrhage. Proper treatments should be used according to the site, onset, and severity of hemorrhage. To prevent its occurrence is the key of treatment.
Objective To evaluate the operative indication and results of pancreaticogastrostomy following pancreaticoduodenectomy. Methods A retrospective study was carried out on the cases of pancreaticoduodenectomy following pancreaticogastrostomy from Aug. 2005 to Feb. 2008 in Shanghai Tongji Hospital. Results During this period, 38 cases had undergone pancreaticogastrostomy with pancreaticoduodenectomy. The median operative time was (352.1±78.3) min. The median intraoperative blood transfusion was (911.3±601.4) ml. The median postoperative length of stay was (26.2±12.1) d. Postoperative morbidity was 21.1% (8/38) with no operative death. Pancreatic anastomotic leakage occurred in 1 patient. Delayed gastric emptying occurred in 2 patients. Incision infection occurred in 2 patients. Abdominal fluid collection occurred in 1 patient and pulmonary infection occurred in 2 patients. All of the complications were treated conservatively. Conclusion Pancreaticogastrostomy is a safer drainage procedure for the pancreatic stump after pancreaticoduodenectomy.
ObjectiveTo summarize the application and the complications of pancreaticogastrostomy (PG) after pancreaticoduodenectomy(PD). MethodThe domestic and international publications involving the theory, methods, and clinical application of PG were retrieved and reviewed. ResultsPG was gradually concerned on the choice of the method of the digestive tract reconstruction after PD, in view of its advantages in theory and operation. The literatures about PG were increased in recent years. But the discussion of decreasing complications of PG after PD had yet to be unified. ConclusionsPG is one of the important operations of digestive tract reconstruction after PD. The factors of operator and patient should be comprehensively considered in the choice of PG.