Release date: 2007-09-10
Application of Fuaile Medical Glue in Pancreatectomy Department of Oncology, First Clinical College, China Medical University, Wang Shubao, Jin Feng, Yao Fan, Chen Bo [Keywords] Pancreatectomy; medical capsule upper stomach often infiltrate the pancreatic body tail, treatment often requires The whole stomach combined with spleen and pancreatic body tail resection; the lower stomach cancer, such as infiltration of the head of the pancreas, must be combined with pancreaticoduodenectomy. A common postoperative complication of this type of surgery is pancreatic stump fistula. The leaked pancreatic juice contains a variety of digestive enzymes, which are mixed with peritoneal exudate to cause chemical peritonitis and abdominal infection. After a variety of treatments, the long-term unhealed, the drainage tube for the control of infection and the abdominal cavity can not be removed for a long time, bringing a great mental burden to the patient. In the past, in order to prevent the occurrence of postoperative pancreatic fistula, clinicians paid more attention to the suture of the pancreatic stump. Some scholars advocate strict suturing of the stump of the pancreas to prevent leakage of pancreatic juice. Some scholars believe that tightly suturing the stump of the pancreas is more likely to cause necrosis of the pancreatic tissue at the suture, and increase the chance of pancreatic fistula. Therefore, loose suture is advocated, and the opinions are not unified. . But in fact, because the texture of the pancreas is very brittle, it is inevitable that the needle eye is sutured outwards in the suture of the pancreatic juice, regardless of whether it is tightly sutured or loosely sutured. In practice, we designed three methods to prevent postoperative pancreatic stump fistula according to different conditions, and the results were very satisfactory. 1. Nested drainage method: After loosening and suturing the stump of the pancreas, the "sleeve drainage tube" made by the condom and the drainage tube is enveloped on the stump of the pancreas, and all the leaked pancreatic juice is drained to prevent the occurrence of pancreatic stump fistula. The production and usage of the "sleeve drainage tube": the top of the condom is cut off, the drainage tube is inserted into the cutting mouth, and the penis sleeve is sewn on the tube wall of the drainage tube with the angle needle 7 to prevent slippage. Can be sewn 2 times. The pancreatic stump is tightly sealed with the lateral end of the penis. If the penis sleeve is too loose after being inserted into the stump of the pancreas, the side of the penis can be tightened with the 7th line to make it close to the stump of the pancreas, and the tightness is moderate. Then, the condom and the stump of the pancreas are connected with Fu Le Le medical glue to prevent slipping. The part of the drainage tube was taken out separately from the abdominal wall, and the nature of the drainage fluid and the drainage were closely observed after operation. We have applied this method to 10 patients in clinical practice. The pancreatic amylase in the drainage tube is 10,000 to 20,000 units, and the pancreatic amylase in the peritoneal drainage solution is only 15 to 20 units. We have observed the drainage volume of a set of drainage tubes that have been eaten for 4 days after surgery. The increase of 180 ml after 24 hours of feeding indicates that the amount of exudate in the pancreatic stump increases with the increase of pancreatic juice secretion. If direct drainage is not possible, it is prone to postoperative pancreatic stump fistula, causing chemical peritonitis and abdominal infection. After the fasting and drainage decreased, 10 patients in this group stopped the perfusion of the pancreatic juice about 10 days after the operation, and pulled out the sleeve drainage tube without abdominal infection. 2. Pancreatic intestine stump medical glue sealing method: after the pancreatic duct ligation of the pancreatic stump, loose suture, the Foucault medical glue is injected into the pancreatic wound. First, the Fu Aile medical glue is sucked into the syringe, and injected into the pancreatic stump at 3 to 4 points. 0.2 to 0.3 ml is injected at each point, and then the Fuai Le medical glue is applied around the needle stump of the pancreas and the suture. We used this method to observe 5 patients, and no drainage was performed. There was no pancreatic fistula after operation. Abdominal drainage was removed 1 week after surgery. Through practical experience, the medical glue has an embolization of the pancreatic duct, forming a firm adhesive film on the surface of the pancreas, preventing the occurrence of pancreatic fistula, and also being used for repairing pancreatic trauma. 3. Main pancreatic duct embolization method: Inferior stomach cancer infiltrating the head of the pancreas or locally advanced pancreatic head cancer, pancreaticoduodenectomy should be performed, the operation is large, and pancreaticojejunostomy is easy to occur. For the safety of surgery, medical use is available. The plastic plug embolizes the main pancreatic duct. Specific operation method: After finding the main pancreatic duct, select the silicone tube with proper caliber, insert the medical glue from the side end of the main pancreatic duct, and then pull out the silicone tube while injecting it, then spray it on the pancreas with Fuerle medical glue. End, do not do pancreaticojejunostomy. After the medical gel plugs the main pancreatic duct, the secretory gland of the pancreas is destroyed, and the other digestive glands replace its function, which does not affect the patient's digestion and absorption function. This method can be used for the risk of surgery or palliative resection. We have performed 12 cases of gastric cancer with partial gastrectomy and pancreaticoduodenectomy. No postoperative diarrhea, dyspepsia, and diabetes were found. [Author] Wang Shubao (1938-), male, professor, doctoral tutor. Reprinted from the Journal of Clinical Surgery, Vol. 13, No. 9, 2005
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