췌공장문합시 췌관 Stent를 경피적으로 배액하는 방법 및 문합부의 감시

다국어 초록 (Multilingual Abstract)

Long Percutaneous Stent Insertion in the Pancreatic Duct and Monitoring of Pancreaticojejunostomy Site Leakage in Periampullary Cancer PatientsSeok Yong Ryu, M.D., Hyeon Chul Kang, M.D., Hong Yong Kim, M.D., Sehwan Han, M.D., Myeong Soo Lee, M.D., Hong Ju Kim, M.D., Young Duck Kim, M.D., Department of Surgery, InJe University, Sanggye Paik Hospital(Background) Periampullary cancer is a relatively common malignancy and its incidence is increasing. Pancreaticoduodenectomy is the procedure of choice to eradicate the disease. However, leakage of the pancreaticojejunal anastomosis has been a major complication after pancreaticoduodenectomy, with a frequently reported incidence ranging from 5 to 25 percent. Various modalities of pancreaticojejunostomy have been investigated, but the ideal management of the pancreatic stump has still not been determined. We undertook this study to determine safe and effective pancreatic stump management and to monitor the security of pancreatic stump anastomosis by body fluid amylase level.(Patients and Methods) Between June 1997 and January 1998, 10 consecutive patients who underwent pancreaticoduodenectomy were evaluated retrospectively.The anastomosis between the pancreatic end and the jejunum was performed either as a duct-to-mucosa or an end-to-end invagination method(Dunking). A long silicone stent was used for intubation of the anastomosis(CSF-Cardiac/peritoneal Cath. inner diameter 1.3 mm, outer diameter 2.5 mm, length 90 cm, Medtronic, Medtronic PS medical, Goleta. CA. USA). External drainage of the long pancreatic duct tube was checked daily by measuring the amount of pancreatic juice. We placed two Penrose and one Jackson-Pratt drains near the anastomosis site during the operation. Patients were monitored for clinical evidence of a pancreatic fistula by analysis of amylase concentration in the serum and peritoneal drainage at 7 days after the operation. The normal range of body fluid amylase was defined as within five times the normal serum amylase level. Cholangiography, obtained through the T-tube or percutaneous transhepatic catheter, was performed 7 days after the operation to assess the leakage or obstruction at any of the three reconstructive anastomosis sites.(Results) No leakage from the pancreaticojejunostomy site was detected. Daily mean amount of pancreatic juice and body fluid amylase level were 76.6ml/day(range 0.4 -137.4ml/day) and 147.4 U/L(range : 44 - 323U/L), respectively.(Conclusion) External long pancreatic duct stent insertion is an effective and safe method for the management of pancreatic remnant. We were able to check daily the amount of pancreatic juice precisely. Effective decompression of P-Jstomy was achieved by long stent insertion. We were able to monitor the security of pancreatic stump anastomosis by measuring the body fluid amylase level. We suggest that our method is effective in the early detection and treatment of P-Jstomy site leakage by monitoring the levels of the body fluid amylase.