Abstract: Objective:To explore the application value and clinical efficacy of one half layer pancreaticojejunostomy with the posterior wall of pancreas reinforced in pancreaticoduodenectomy.
Methods:The retrospective crosssectional study was conducted.The clinical data of 17 patients with pancreatic neoplasms and ampullar neoplasms who underwent pancreaticoduodenectomy at the Second Affiliated Hospital of Harbin Medical University from May to September 2015 were collected. One half layer pancreaticojejunostomy with the posterior wall of pancreas reinforced method was applied to the digestive tract reconstruction after pancreaticoduodenectomy in the 17 patients. Observation indicators included: (1)surgical situations: surgical procedures, operation time, time of pancreaticojejunostomy, volume of intraoperative blood loss, tumor sizes, (2)postoperative situations: recovery time of gastrointestinal function, postoperative complications, duration of postoperative hospital stay, (3)postoperative pathological examinations, (4)followup. Patients were followed up by outpatient examinations including color Doppler ultrasound or abdominal computed tomography（CT） and telephone interview detecting abdominal pain or distention and general situations (diet, sleep) up to October 2015. Measurement data were represented as average (range).
Results:(1) Surgical situations: all the 17 patients underwent successful operations without perioperative death, including 16 undergoing radical pancreaticoduodenectomy and 1 undergoing pancreaticoduodenectomy and left liver resection. The average operation time, average pancreaticojejunostomy time, average volume of intraoperative blood loss and average tumor size were 276 minutes (range, 230- 440 minutes), 12 minutes (range, 9-16 minutes), 310 mL (range, 200-950 mL) and 3.25 cm² (range, 1.92 -5.60 cm²), respectively. (2) Postoperative situations: the average recovery time of gastrointestinal function was 3 days (range, 1-7 days). Three patients had postoperative complications, including 1 patient with pancreatic fistula (Grade A) and 2 patients with delayed gastric emptying, and all of them had been healed after symptomatic and supportive treatments. The results of Ttube cholangiography or CT before hospital discharge showed that there was no leakage around the anastomoses.The average duration of postoperative hospital stay was 10 days(range, 6-20 days). (3) The postoperative pathological examinations showed 5 patients of pancreatic ductal adenocarcinomas, 4 of common bile duct ampulla area adenocarcinomas, 3 of duodenal papillary adenocarcinomas, 3 of pancreatic intraductal papillary mucinous neoplasms and 2 of duodenal ampullary adenocarcinomas. (4) Followup: all the 17 patients were followed up for 1-4 months and the abdominal color Doppler ultrasound or CT showed that there was no evidence of tumor recurrence or leakage around anastomoses.
Conclusion:One half layer pancreaticojejunostomy with the posterior wall of pancreas reinforced is safe and feasible, and it can reduce the rate of pancreatic fistula successfully.