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目的探讨胰十二指肠切除保留幽门后消化道重建原位胰胃吻合、肠肠吻合、胆肠吻合的临床疗效。方法对5例壶腹周围肿瘤行胰十二指肠切除保留幽门后,采用原位吻合方式,即胰胃吻合、十二指肠—空肠吻合、肝总管—空肠吻合方式重建消化道。胰胃吻合于胃后壁直接切口,黏膜与胰管、胃浆基层与胰断端直接吻合。结果术后随访1个月~15个月,5例病人中,近期并发胃排空延迟(呕吐)1例(1/5),腹腔感染1例(1/5),无明显胰、胆瘘发生,无上消化道出血病例。远期无胰功能不足及胃肠溃疡等并发症发生。结论保留幽门原位消化道重建、胰胃吻合创伤小,术后恢复快,更符合生理机制,胆胰瘘发生率低,是胰十二指肠切除后消化道重建的优良术式。
Objective To investigate the clinical effect of pancreatoduodenectomy for the preservation of pyloric post-digestive tract reconstruction in situ pancreatic anastomosis, intestinal anastomosis and biliary-enteric anastomosis. Methods Five cases of periampullary tumors were treated with pancreatoduodenectomy and retained pylorus. In situ anastomosis was used, ie pancreas-gastric anastomosis, duodenal-jejunal anastomosis, hepatic tube-jejunal anastomosis to reconstruct the digestive tract. The pancreas and the stomach were anastomosed to the posterior incision of the stomach, and the mucosa and the pancreatic duct, the stomach paste base layer and the pancreas end were directly anastomosed. Results The follow-up period was 1 month to 15 months. Among the 5 patients, there were one case (1/5) of delayed gastric emptying (vomiting), one case (1/5) of abdominal cavity infection, and no obvious pancreatic and cholestasis. Occurrence, no cases of upper gastrointestinal bleeding. Long-term lack of pancreatic insufficiency and gastrointestinal ulcers and other complications. Conclusion The preservation of pylorus in situ digestive tract reconstruction, pancreaticogastric anastomosis trauma, rapid recovery, more consistent with physiological mechanisms, low incidence of biliary pancreatic fistula, is an excellent surgical procedure for reconstruction of the digestive tract after pancreatoduodenectomy.