保留十二指肠胰头切除术中消化道重建方式的选择OA

Objective To explore the scope of application of duodenum-preserving pancreatic head resection(DPPHR),as well as the types,application scopes and effects of digestive tract reconstruction methods.Methods A retrospective analysis was conducted on the clinical data of 24 patients who underwent DPPHR at the Second Affiliated Hospital of Zhejiang University from February 2012 to December 2024.According to different digestive tract reconstruction methods,the patients were divided into three groups:the pancreatic duct-jejunostomy group(n=15),the choledochojejunostomy group(n=4),and the pancreatic duct end-to-end anastomosis group(n=5).Results All cases in this study successfully completed pancreatic head resection as planned,with no deaths.Postoperative complications were as follows:a total of 9 cases of pancreatic fistula occurred,including 6 cases in the pancreatic duct-jejunostomy group,1 case in the choledochojejunostomy group,and 2 cases in the pancreatic duct end-to-end anastomosis group;there were 3 cases of intra-abdominal bleeding,among which 1 case achieved successful hemostasis via DSA(digital subtraction angiography),and 2 cases achieved successful hemostasis through reoperation.No postoperative intestinal obstruction occurred in all cases.Before discharge,the liver function of all cases returned to normal,with no manifestations of biliary stricture or cholangitis,and all patients were discharged after recovery.Conclusion Pancreatic duct-jejunostomy is the most commonly used reconstruction method,which is suitable for most cases of pancreatic head resection.For patients with biliary diseases who cannot retain the lower segment of the common bile duct due to the diseases themselves,reconstruction methods such as pancreatic duct-jejunostomy,choledochojejunostomy,and double Roux-en-Y enteroenterostomy can be performed without duodenectomy.Pancreatic duct end-to-end anastomosis can be used as a digestive tract reconstruction method for some patients undergoing pancreatic head resection,which does not change the original anatomical pathway of the intestine and reduces the complexity of the operation.