The Application Of Pancreatic Duct To Jejunal Mucosa Continuous Lamellar Anastomosis In Pancreaticoduodenectomy

Background and purposePancreaticoduodenectomy is the main surgical treatment of bile duct tumor,periampullary carcinoma,duodenal malignant tumor,carcinoma of head of pancreas.However,some complications such as pancreatic fistula,bleeding,biliary fistula,gastric emptying disorder and so on after whipple surgery can seriously influence the effect of surgery,some serious complications can even threaten the lives of patients.The most relevant complication is pancreatic fistula,the incidence rate of pancreatic fistula of different research centers is different from 2% to 24%,pancreatic fistula after pancreatoduodenectomy is a difficult problem in operation even related to the success or failure of the surgery,the results showed that the mortality rate of pancreatic fistula after whipple was close to 10%.The presence or absence of pancreatic fistula is affected by many factors,including some of the factors that can not be changed,such as gender,age,body mass index,etc.However,the influencing factors include some controllable factors,such as the reconstruction of the pancreas and intestine,perioperative management,surgical techniques,surgical resection range,and so on.One of the most important factors is the reconstruction of pancreas and intestine.The way of pancreatic intestinal anastomosis has been evolving since the birth of whipple operation.It can be described in a variety of ways,but as of now,thebest way to rebuild is inconclusive,this field is controversial.Our center is dedicated to the study of the method of pancreas intestinal reconstruction,Based on the traditional method of end to side anastomosis,a new method of anastomosis was established ? pancreatic duct to jejunal mucosa continuous lamellar anastomosis.According to clinical observation,the clinical effect of this anastomosis is satisfactory,The purpose of this study was to evaluate the clinical application effect,to compare and explore the difference of the stress response between the anastomosis method and the end to end anastomosis applied to human body.Materials and methodsA retrospective analysis of the clinical data of 168 patients from January 2011 to December 2015 in our hospital receiving pancreaticoduodenectomy for malignant tumor,including 86 patients who had been treated with pancreatic duct to jejunal mucosa continuous lamellar anastomosis(experimental group),the other 82 patients underwent conventional pancreaticojejunal end-to-end anastomosis(control group).The general situation,intraoperative condition,postoperative condition and postoperative complications of two groups were compared,the C-reactive protein,white blood cell count,neutrophil percentage of two groups on the first day,third day and seventh day after operation were compared.ResultsThere was no significant difference(P>0.05)in gender,age,American Society of anesthesiologists grade(ASA grade),BMI,concomitant disease,history of abdominal surgery,preoperative biliary drainage,Surgical etiology,preoperative laboratory detection index,diameter of pancreatic duct,pancreatic texture between pancreatic duct to jejunal mucosa continuous lamellar anastomosis group(experimental group)and pancreaticojejunal end-to-end anastomosis(control group).In experimental group,the time of intestinal anastomosis,the amount of intraoperative bleeding,postoperative feeding time,postoperative hospital stay,hospitalization costs were significantly lower than those of control group,thedifference was statistically significant(P<0.05);In experimental group,the incidence of pancreatic fistula was significantly lower than that of control group,the difference was statistically significant(P<0.05);There was no significant difference in abdominal bleeding,abdominal pain,high fever,gastric emptying disorder and wound infection complications between the two groups(P>0.05);There was no significant difference in the clinical outcome of reoperation and perioperative death between group and control group(P>0.05);the white blood cell count,neutrophil percentage,C reactive protein stress index of experimental group of first day,third day and seventh day after operation were significantly better than the control group,the difference was statistically significant(P<0.05).ConclusionThe short-term effect of pancreatic duct to jejunum mucosa continuous lamellar pancreaticojejunostomy in pancreaticoduodenectomy is satisfactory,but the number of cases of the clinical application of this anastomosis is small,the reliability,safety and rationality remains to be further confirmed by randomized controlled trials and a large amount of case analysis.