Clinical Analysis Of Pancreatic Duct-jejunal Mucosal Anastomosis And Modified Invaginal Pancreatico-intestinal Anastomosis In Pancreatoduodenectomy

Objective:To investigate the clinical curative effect of pancreatic duct-jejunum mucosa anastomosis and modified invagination of pancreatico-intestinal anastomosis in pancreatoduodenectomy to provide the basis for the clinical choice of pancreaticojejunostomy to further reduce the incidence of postoperative pancreatic fistula,hemorrhage,Abdominal infection and other complications of the risk.Methods:A non-randomized controlled clinical trial was conducted in 102 patients undergoing pancreatoduodenectomy from September 2013 to September 2017 in Xinmin department of our hospital.The patients in both groups were anastomosed The methods were all routinely selected Child operation,which was divided into two groups according to the anastomosis of the pancreas: the pancreatic duct-jejunal mucosa anastomosis group(54 cases)and the modified invaginal pancreaticojejunostomy group(48 cases).Combined with the operation time,The duration of operation,the duration of postoperative hospital stay,postoperative complications(pancreatic fistula,hemorrhage,abdominal infection,gastric emptying,lung infection)and their severity were compared between two different methods of pancreaticojejunostomy The impact of pancreatic fistula and other complications.Data using SPSS analysis software statistical analysis.Results :The average duration of pancreatic and intestinal anastomosis,average bleeding volume and average length of hospital stay were(25.15 ± 15.52)min,(365.46 ± 153.64)ml,(14.56 ± 5.23)d and(40.35 ± 23.73)min,(479.73 ± 231.36)ml and(20.62 ± 4.13)d respectively.There was significant difference between the two groups(P <0.05).One patient died of postoperative bleeding in the pancreatic duct-jejunum mucosa anastomosis group.There was no postoperative bleeding and death in patients with improved anastomosed pancreaticojejunostomy,and the incidence of postoperative pancreatic fistula was 6.25%(3/48)in the modified anastomosed pancreaticojejunostomy group,which was significantly lower than that in pancreatic duct-jejunal mucosa anastomosis group Of 25.93%(14/54),the difference was statistically significant(P <0.05).The rates of postoperative bile leakage,delayed gastric emptying and pulmonary infection were 2.1%(1/48)and 4.2%(2/48)respectively in the modified anastomosed pancreaticojejunostomy group and the pancreatic duct-jejunum mucosa anastomosis group),6.3%(3/48)and 3.7%(2/54),7.4%(4/54)and 5.6%(3/54)respectively.There was no significant difference between the two groups(P> 0.05).Conclusion:The improved invaginal pancreaticojejunostomy can significantly reduce the incidence of pancreatic fistula after pancreatoduodenectomy,and can shorten the hospital stay,which is a simple and reliable anastomosis of pancreaticojejunostomy.