Different Ways Of Pancreatic Stump And Digestive Tract Reconstruction In Relation To Postoperative Pancreatic Fistula

Objective: To explore application of three different ways of pancreatic stump and digestive tractreconstruction in relation to postoperative pancreatic fistula in pancreaticoduodenectomy..Methods:Retrospective analysis the clinical data of the82cases patients who were operatedpancreaticoduodenectomy(PD) during October2010to December2012in the second clinicalhospital of Jilin university.According to the different ways of pancreatic stump and digestive tractreconstruction divided into end-to-end invaginated pancreaticojejunostomy group,end-to-sideinvaginated pancreaticojejunostomy group,end-to-side duct-to-mucosa pancreaticojejunostomygroup.Three groups of cases respectively were23cases,24cases,28cases.Two kinds ofanastomosis operation respectively is bundled pancreaticojejunostomy group andpancreaticogastrostomy group. Cases in each group respectively are4cases,3cases. Mainly tocompare and analyse the occurrence of pancreatic fistula(PF) and other complications,operationtime,intraoperative blood loss and blood transfusion,average days of hospitalization, volume andamylase levels of abdominal cavity drainage liquid of3and7days after surgery between the frontof the three groups.Results:Of the82patients,the incidence rate of overall complication were35.4%(29/82),including19cases of PF, PF incidence is23.2%(19/82), mortality rate is4.9%(4/82). Other complications including2cases of biliary fistula，2cases of intra-abdominalhemorrhage,2cases of digestive hemorrhage,4cases of abdominal infection,4cases ofpulmonary infection,6cases of gastroplegia occurred.compare the operation time,intraoperativeblood loss and blood transfusion, fart time of postoperation,average days of hospitalizationbetween the front of the three groups.The result showed P>0.05. There was no significantdifferences in these threegroups.The volume and the amylase levels of abdominal cavity drainageliquid of3and7days after surgery and PF rate of the end-to-side duct-to-mucosapancreaticojejunostomy group were significantly lower than other groups.The result showedP<0.05.Difference was statistically significant. The rest of the two groups of comparison wasp>0.05. There was no significant differences in these groups.In total19cases of PF,17cases werehealed after anti-infection, parenteral nutrition, Inhibition of pancreatic enzymes, Delayedextubation time etc.1case of the end-to-end invaginated pancreaticojejunostomy group occurredintra-abdominal hemorrhage and abdominal infection. Although conducted positive treatment butdied due to multiple organ dysfunction syndrome.1case of the end-to-side duct-to-mucosapancreaticojejunostomy group occurred biliary fistula, intra-abdominal hemorrhage. Although conducted Intervention hemostatic treatment but died due to multiple organ dysfunctionsyndrome.The rest tow dead cases respectively belong to the end-to-end invaginatedpancreaticojejunostomy group and the end-to-side duct-to-mucosa pancreaticojejunostomygroup.The cause of death of the former is abdominal infection.The latter died from biliary fistula.Conclusion: Through this study, compare five different ways of pancreatic stump and digestivetract anastomosis what were used in82cases of Pancreaticoduodenectomy,we came to aconclusion that the end-to-side duct-to-mucosa pancreaticojejunostomy of the pancreatic fistulaincidence was significantly lower than the rest of the four types of this research. Prove that theoperation can effectively reduce the incidence of pancreatic fistula, is a worthy of promotion.There is no a operation method can be suitable for use in all cases.We should comprehensivelyconsider the experience of performer and proficiency in operating, pancreas itself andintraoperative situation choose the most reasonable way of pancreatic stump and digestive tractanastomosis, to minimize the incidence of pancreatic fistula.