A Comparative Analysis Of Pancreaticojejunal Bridge-anastomosis And Duct-to-mucosa Anastomosis

Objective: Pancreatoduodenectomy(PD)is an important method for the treatment of benign and malignant diseases of the pancreas.Because of its many postoperative complications and high mortality,many surgeons turn pale at the mention of it.After decades of development of PD,pancreaticojejunostomy(PJ)has formed many derivations.Among them,the pancreaticojejunal bridge-anastomosis(PJBA)is a new type of PJ that has been innovatively applied to clinical treatment in recent years.This study mainly compared the incidence of related complications such as pancreatic fistula(POPF),postoperative biliary fistula(POBF),and delayed gastric emptying(DGE)postoperative bleeding,etc.in pancreaticoduodenectomy with pancreaticojejunal bridge-anastomosis and duct-to-mucosa anastomosis and explored the significance of pancreaticojejunal bridge-anastomosis for clinical treatment.Methods: This study selected 47 patients undergoing pancreatoduodenectomy from June 2014 to June 2016 in Shengjing Hospital Affiliated to China Medical University.Among them,20 patients underwent pancreaticojejunal bridge-anastomosis while 27 patients with duct-to-mucosa anastomosis.The clinical data of the two groups during the perioperative period and statistical analysis were used to compare intraoperative conditions,postoperative rehabilitation and the incidence of complications such as postoperative pancreatic fistula,postoperative biliary fistula,delayed gastric emptying,pneumonia,incision infection,and abdominal infection and postoperative bleeding.Results: By analyzing intraoperative conditions and postoperative complications of pancreaticojejunal bridge-anastomosis and duct-to-mucosa anastomosis,the results showed operation time(h)of PD with the pancreaticojejunal bridge-anastomosis and duct-to-mucosa anastomosis were 6.68±0.89,7.46±1.10(P=0.012);intraoperative blood loss(ml)were 397.50±283.06,326.67±144.01(P=0.268);postoperative gastric tube removal time(d)were 9.85±5.58,11.22±10.08(P=0.586);postoperative feeding time(d)were 7.15±4.09,10.07±10.18(P=0.232);pancreatic fistula incidence was 10% and 44.4%(P=0.026);the incidence of postoperative biliary fistula was 0% and 0%;the incidence of gastric emptying was 5.0% and 7.4%(P=0.739),and the incidence of postoperative bleeding was 5.0% and 14.8%(P=0.548);the incidence of intra-abdominal infection was 15.0% and 0(P=0.070),respectively.It showed statistical significance in the time of operation,the incidence of postoperative pancreatic fistula,postoperative hospital stay,etc.There was no statistically significant difference in in the aspects of blood loss during surgery,postoperative feeding time,bile fistula,gastric emptying dysfunction,postoperative bleeding,incision infection,abdominal cavity infection.Conclusion: Compared with duct-to-mucosa anastomosis,pancreaticojejunal bridge anastomosis is more safe and reliable,it has the advantages of convenient operation,shortened operation time and less postoperative pancreatic fistula incidence.Abdominal infection,postoperative bleeding and other troublesome complications were avoided as much as possible.Patients can quickly restore and discharge early.In addition,duct-to-mucosa anastomosis has also achieved good results in the control of other complications.It can be used as a routine pancreaticojejunostomy in clinical PD,and is particularly suitable for patients with poor basic conditions.