幽門輪温存膵頭十二指腸切除後膵液瘻に対する瘻孔胃吻合術  [in Japanese] FISTULOGASTROSTOMY FOR INTRACTABLE EXTERNAL PANCREATIC FISTULA FOLLOWING PYLORUS PRESERVING PANCREATODUODENECTOMY  [in Japanese]

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Abstract

PpPD術後に難治性膵液瘻となった2例に対して瘻孔胃吻合術を行い,良好な結果を得た.症例:十二指腸乳頭近傍のIIc型早期癌と下部胆管癌の2例.両症例ともPpPDを施行し,再建はPpPD-III型で行った.術後膵液瘻となり,吻合部のドレーンを徐々に6 Frまで細くした.瘻孔造影にて主膵管は造影されるが腸管との交通は認めなかった.方法: 8カ月後および6カ月後に瘻孔胃吻合術を施行した.瘻孔周囲に皮切を加え上下に延長して開腹.瘻孔を損傷しないように注意して剥離し,胃の小彎まで剥離すると約3cmの長さとなった.胃の漿筋層を約3cm切開し粘膜下層を露出し,粘膜にタバコ縫合をかけ,チューブを入れた瘻孔を胃内に挿入するように縫着した.漿筋層を被せるように縫合し,チューブは胃前壁から出した.結果: 2例とも術後膵炎や膵嚢胞の形成はなく経過は良好であった.手技も容易であり,本法は有用であった.

Two cases of intractable complete external pancreatic fistula following pylorus preserving pan-creatoduodenectomy (PpPD) were successfully treated by fistulogastrostomy. Cases: PpPD was perfor-med in two cases of early duodenal cancer and lower bile duct cancer. Insufficient pancreatojejunostomy resulted in complete external pancreatic fistula. Fistulography after conservative treatment revealed complete obstruction at the anastomosis. Fistulograstrostomy was performed 8 months and 6 months after the initial operation, respectively. Method: Skin incision was placed around the external orifice. The fistula was dissected carefully from surrounding tissue until the minor curvature of the stomach appeared. The fistula of 3cm in length was obtained and a 6 Fr drainage tube was inserted into the fistula. Seromytomy was placed on the anterior wall of stomach, tip of the fistula was sutured to the stomach mucosa, and the fistula was covered by seromuscular layer. The drainage tube was extracted through the anterior wall of stomach. Result: Postoperative course was uneventful in both cases with no abnormal elevation in serum amylase nor formation of pancreatic pseudocyst. This procedure is easy to perform and useful in the treatment of complete external pancreatic fistula following PpPD.

Journal

  • The journal of the Japanese Practical Surgeon Society

    The journal of the Japanese Practical Surgeon Society 56(7), 1388-1391, 1995-07-25

    Japan Surgical Association

References:  12

Cited by:  1

Codes

  • NII Article ID (NAID)
    10008514447
  • NII NACSIS-CAT ID (NCID)
    AN00198696
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    03869776
  • Data Source
    CJP  CJPref  J-STAGE 
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