Abstract: Objective:To investigate the application value of end to end invagination pancreaticojejunostomy with discontinuous U suture in the  pancreatic head cancer.
Methods:The clinical data of 48 patients with  pancreatic head cancer who were admitted to the ChinaJapan Union Hospital of Jilin University from January 2006 to January 2012 were retrospectively analyzed. Patients underwent pancreaticoduodenectomy and radical resection of tumors in the head of pancreas via upper approach after abdominal exploration, and pancreatic stents were placed for internal drainage of pancreatic duct. The digestive tract was reconstructed by Child method. With pancreatic stump anchored into the jejunum, the jejunum was discontinuously sutured with pancreas, and the whole layers were discontinuously sutured with pancreatic capsule by circle U type at approximately 0.5 cm from pancreatic stump. The signs of abdominal infection, nature and amount of fluid drainage from pancreaticojejunostomy anstomosis were observed. Patients were followed up till December 2014. The survival curve was drawn by KaplanMeier method.
Results:Fortyeight patients underwent pancreaticoduodenectomy successfully without intraoperative death, with operation time of (4.1±1.2)hours and volume of blood loss of (363±89)mL. There were 6 patients with postoperative complications, including 3 cases of pancreatic fistula, 2 cases of lung infection and 1 case of incision infection. Among 3 cases of pancreatic fistula, 2 cases were in grade A and cured latterly, 1 case was in grade C and died because of abdominal bleeding. The other 3 patients were cured by conservative treatment. None of the patients had postoperative complications such as abdominal abscess or upper gastrointestinal hemorrhage. The postoperative removal time of abdominal drainage tube and duration of hospital stay were (9±4)days and (15.6±2.8)days. The results of pathological examination showed that adenocarcinoma was detected in 43 patients, including 3 cases of high differentiation, 27 cases of middle differentiation, 9 cases of middlelow differentiation and 4 cases of low differentiation, neuroendocrine carcinoma in 3 patients, acinar cell carcinoma was detected in 1 patient and sarcomatoid carcinoma in 1 patient. There was no carcinoma left at pancreatic, biliary and intestinal stumps. Thirtysix patients of the 47 patients were followed up for 2-8 years with the 1, 3year survival rate of 57.6% and 18.7%. No pancreaticjejunostomy anstomotic stenosis was detected during the followup.
Conclusion:The end to end invagination pancreaticojejunostomy with discontinuous U suture has a rational design and it is simple to operate, safe and reliable in pancreaticoduodenectomy for pancreatic head cancer.