Abstract: Objective:To investigate the application value of sleeve pancreaticojejunostomy in digestive tract reconstruction.
Methods:The clinical data of 40 patients who underwent sleeve pancreaticojejunostomy at the Affiliated Hospital of Luzhou Medical College between July 2013 and February 2015 were retrospectively analyzed. The head of pancreas and duodenal descending part were drifted out through Kouch technique, sections were sutured in braidlike U shape and the small pancreatic ducts were closed. The posterior wall of pancreatic stump and jejunal wall were sutured routinely and main pancreatic tube was implanted by silica gel with the thrum retained. The reserved lines were gone through at 6 o′clock and 12 o′clock in the jejunal wall to be sutured and knotted, making the jejunal mucosa set on the surface of main pancreatic duct like sleeve, and then the anterior wall pancreatic stump was sutured. The intraoperative situation and amylase concentration of drainage at post operative day 1, 3, 5, 7 were observed and monitored. The patients were followed up for liver function, tumor markers, abdominal color Doppler ultrasound every 3 months and enhanced abdominal computer tomography every 6 months till May 2015. Measurement data with skewed distribution were presented as M(Qn) and analyzed by ranksum test. Measurement data with normal 〖HJ〗distribution data were presented as ±s. Repeated measurement data were analyzed by the repeated measures ANOVA. Results:All the 40 patients underwent sleeve pancreaticojejunostomy successfully. The duration of operation and pancreaticojejunostomy were (6.2±1.3) hours and (15±6) minutes, respectively. The volume of intraoperative blood loss was (370±55)mL and diameter of tumor was (2.5±1.5)cm. The amylase concentrations of drainage at postoperative day 1, 3, 5, 7 were 46.300 U (35.575 U, 68.600 U), 34.900 U (21.050 U, 55.550 U), 26.750 U (0.000 U, 41.400 U) and 0.000 U(0.000 U, 30.500 U), showing decrease trend with the time gone (F=97.268，P<0.05). Among the 40 patients, 2 had increase of drainage amylase concentration at anastomotic stoma with the drain amount less than 50 mL/d, showing normal temperature, no signs of abdominal pain and peritonitis and potential pancreatic leakage, they were recovered after symptomatic and supportive treatments. The other patients had no complications such as anastomotic leakage and hemorrhage. The duration of hospital stay of 40 patients was (18±5)days. Thirtynine patients were followed up for 3-15 months, showing no postoperative anastomotic stenosis, acute or chronic pancreatitis and pancreatolithiasis, 1 of whom with recurrence tumor.
Conclusion:Sleeve pancreaticojejunostomy is easy to master, safe and reliable, and it is suitable for soft pancreatic tissue.