Comparison Of Clinical Effect Between Binding Pancreaticojejunostomy And Binding Pancreaticogastrostomy

Objective Through the Pancreaticoduodenectomy(PD) with residual pancreatic and digestive tract reconstruction by the way of Binding Pancreaticojejunostomy(BPJ) or Binding Pancreaticogastrostomy(BPG) combined with multi-center prospective randomized controlled clinical trials, to discuss clinical effect by comparative study of BPJ and BPG.Methods There’er total six professional study teams including Professor Xiu-Jun Cai team and Dei-Fei Hong team in SRRS Hospital Affiliated to Medical School of Zhejiang University、Professor Ying-Bin Liu team in Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine、Professor Ren-Yi Qin team in TongJi Hospital Affiliated to TongJi Medical College of Huazhong University of Science and Technology、Professor Yun-Fu Cui team in the Second Affiliated Hospital of Harbin Medical University and Professor Jiang-Tao Li in the Second Affiliated Hospital of Medical School of Zhejiang University. In this prospective double-blind randomized controlled clinical trials,136cases who underwent PD were recruited from general surgery department of multi-center between November2009and January2012.A11the patients are randomized divided into two treatment groups:BPJ group and BPG group. To evaluate the clinical effect of these two anastomosis by analyzing post-operation incidences of complication about pancreatic fistula、delayed gastric emptying、post-operative hemorrhage、bile leakage、intra-abdominal infection、 death、re-operation. Besides, post-operative recovery situation about anus exhaust time、 feeding time and post-operative hospitalization period stay were also evaluated.Results There were total136cases,53cases were with BPJ,83cases were with BPG. The two treatment groups were comparable in multiple parameters, including demographics, medical history(smoking history、drinking history、hypertension、 diabetes、previous history of abdominal operation),symptom(abdominal pain、jaundice), pre-operative laboratory values(serum amylase、abdominal induced fluid), pre-operative hospitalization time; There is not existing significant difference (P>0.05). The two groups were comparable. But the history of gastric and duodenal ulcer is existing significant difference(P<0.05).Comparing BPJ with BPG in operative time、blood loss、 blood transfusions、pancreatic texture、pancreatic free length、pancreatic duct stump diameter, there were also not existing significant difference (P>0.05). Moreover, there were not existing significant difference in post-operative anus exhaust time, taking off gastric tube time, feeding time and post-operative hospitalization period stay etc.In BPJ group among53cases, there’er complications of5gastroparesis cases,3incision infection cases、6pancreatic fistula cases(The incidence of pancreatic fistula is11.3%)、2bile leakage cases、1peptic ulcer case、1intra abdominal abscess case、2pneumonia cases and1arrhythmia case. One died because of intra abdominal hemorrhage and MODS on post-operation day5(Death rate is1.9%).83cases were with BPG, among whom11had the complication of gastroparesis、1had incision infection、5had pancreatic fistula (The incidence of pancreatic fistula is11.3%)、1had cholangitis、5had bile leakage、1had peptic ulcer、1had intestinal fistula、1had intra abdominal abscess、7had pneumonia and1had arrhythmia, all of them were treated conservatively cured.3cases had complication of hemorrhage of upper digestive tractombining occurred on the post-operation day2、2、7respectively (The incidence is3.6%). All were founded pancreatic stump bleeding after exploration. No cases with the complication of death (Death rate is0%)Conclusion The incidence of pancreatic fistula in BPG group is lower than BPJ group, the incidence of bile leakage and delayed gastric emptying in BPG is higher than BPJ. But there is not existing significant difference (P>0.05) between them. Post-operative recovery index is also not existing significant difference. Compared with traditional pancreaticogastrostomy and pancreaticojejunostomy reported, BPJ and BPG are both safe and effective ways as pancreatic and digestive tract reconstruction way in PD.