The Clinical Efficacy Analysis Of Pancreatic Jujunal Anasomosis Bridging In Pancreaticoduodenectomy

Objective: Through retrospective analysis of comparative study of clinical results in Pancreatic jejunal anastomosis bridge with the other two Pancreaticojejunostomy ways after Pancreaticoduodenectomy. We hope to investigate the Pancreatic jejunal anastomosis bridge’s application value in pancreaticoduodenectomy.Methods: Collected the clinical datas of 124 patients who have underdone PD in Hepatobiliary Surgery in the Fourth Hospital of Hebei Medical University between January 1st in 2012 and November 30 th in 2013. The datas were divided into three groups. 66 cases who have undergonepancreatic jejunal anastomosis bridge were assigned to group A.32 casesin group B, who have undergone end to side pancreatic duct jejunumanastomosis, The remaining 26 cases in group C have undergone end to side penetrating suture pancreaticojejunostomy. We collected the pancreaticojejunostomy time, operation time, postoperative hospitalization time and postoperative complications from each group. Postoperative complications includ: pancreatic fistula, postoperative bleeding, delayed gastric emptying, abdominal cavity infection and death. Comparisons of the pancreaticojejunostomy time, operation time, postoperative hospitalization time were done, The incidence of postoperative complications and mortality from each group were conducted to investigate the superiority of pancreatic jejunal anastomosis bridge in PD. All data were analyzed through SPSS 13.0 statistical software, The measurement data expressed as mean±standard deviation of( X ?s). Comparison between the two groups were conducted using T-test, and the relationship among groups were compared using ANOVA, What’s more, univariate analysis was carried out by chi-square test, the difference was statistically significant if P<0.05.Results: Average pancreaticojejunostomy time of group were(15.83±3.72) min,(24.91±3.50)min and(22.27±5.09)min, The difference was statistically significant(P < 0.05). Group A’s pancreaticojejunostomy time was shorter than the other two groups, and the difference was statistically significant(P<0.05). On the contrary, group B’s pancreaticojejunostomy time was longer than the other two groups and the difference was statistically significant(P<0.05). Average postoperative hospitalization time of group A, B and C were(15.56±4.22)d,(16.18±3.63)d and(16.84±4.46)d, the difference was no statistically significant(P>0.05). In 124 cases with no deaths and postoperative bleeding in the belly. The total postoperative complications were 10 cases(8.06%). In group A, the postoperative complications were 3 cases(4.56%). in group B, there was only one case(3.13%) of pancreatic fistula after operation and 6 cases(23.08%) of postoperative complications after operation in group C. Postoperative complications of three groups had significant difference in the incidence, and the difference was statistically significant(P<0.05). Where A, B postoperative complications of two groups had no significant difference, group C was higher than other two groups of the incidence of postoperative complications, and the difference is statistically significant(P<0.05). The respective incidence of pancreatic fistula after operation in group were 1 case(1.52%),1 case(3.13%) and 5 cases(19.23%), and the difference was statistically significant(P<0.05). the incidence of pancreatic fistula in group C was higher than group A, and the difference was statistical significant(P<0.05). No significant differences were noted in the incidence of abdominal infection and delayed gastric emptying among the three groups.Couclusions: The preliminary results of the study Indicate that pancreatic jujunal anasomosis bridging is more simpler than other two types of pancreaticojejunostomy method, and the incidence of postoperative complications, pancreatic fistula rate is relatively low, and hospitalization time is relatively short. Therefore, it is a good method of Pancreaticojejunostomy in PD and we can use it widely. Although pancreaticojejunostomy method varied, there is still safety concern that we still need ideal anastomosis which can completely eliminate the occurrence of pancreaticfistula. Each anastomosis method has its own advantages, but also has itsown deficiency. Continuous improvement of pancreatojejunostomy purpose is as far as possible to make Pancreaticojejunostomy more convenient operation and can effectively reduce the incidence of postoperative complications. But it is worth noting that different doctors using the same anastomosis technique may produce different postoperative results. However, the doctor should use the method with caution when patients havea thin pancreatic duct. We’d better master this method in our daily work. In addition, The occurrence of pancreatic fistula is also related to the nutritional status of patients, postoperative management and some other factors. Although the method of anastomosis is very important the doctor must establish the overall concep of patients, in order to achieve the best clinical effect.