Objective The
risk of current
pancreaticojejunostomy is carefully considered from the perspective of the morphology of remnant
pancreas,and we aimed to discuss the clinical outcomes of selecting different
pancreaticojejunostomy techniques based on pancreatic morphology.
Methods This was a prospective
cohort study.The histopathology of remnant pancreatic
tissues was categorized into four types based on preoperative radiological images and intraoperative
palpationType Ⅰ
pancreas with hard texture in
palpation,pancreatic
atrophy,dilated
pancreatic duct larger than 5 mm and remnant pancreatic surface <3 cm;Type Ⅱ
pancreas with hard texture in
palpation,pancreatic
atrophy and mild
dilatation of
pancreatic duct with the diameter of 3-5 mm and remnant pancreatic surface <3 cm;Type Ⅲ
pancreas with slightly hard texture,no
atrophy,and normal or slightly dilated
pancreatic duct with the diameter of 3-5 mm and remnant pancreatic surface ≥3 cm;Type Ⅳ
pancreas with soft texture,normal morphology and
pancreatic duct.Results From January 2008 to August 2017,116 consecutive
patients underwent
pancreaticoduodenectomy in our center.Among them,10
patients with type Ⅰ underwent classic pancreatic ductal
mucosa to
mucosa anastomosis.19
patients with type Ⅱ underwent classic end to end invaginated
pancreaticojejunostomy.45
patients with type Ⅲ underwent classic end to end invaginated
pancreaticojejunostomy with overlapping U
sutures;42
patients with type Ⅵ underwent total invaginated
pancreaticojejunostomy.The post-operative
pancreatic fistula occurred in 6
patients (5.2%) with one
patient died.Postoperative
bleeding occurred in 10
patients (8.6%),and
gastroparesis occurred in 22
patients (19.0%).Overall complication rate was 33.6%.Conclusions
Classification of pancreatic morphology based on preoperative radiological images and intraoperative
palpation and the selection of corresponding
pancreaticojejunostomy technique is theoretically rational and has the advantage of potentially reducing the
risk of remnant pancreatic
tissue.