研究一种安全可靠、简单通用的全新的胰腺吻合方法——贯穿缝合式胰肠端侧吻合术（PPJ）。

总结泰兴市人民医院普外科2002年5月至2012年6月间47例应用PPJ行胰肠吻合（端端吻合6例，端侧吻合41例）的临床经验和手术方法。设计理念是手术时把胰腺切断看作是一个实质性器官（而非空腔器官），用胰腺切断全层（而非切缘）与空肠进行吻合。一针贯穿缝合胰腺切断全层和空肠后、前壁全层，间断缝合6~8针同时完成胰腺切面与空肠前、后壁的吻合。主胰管内放置短的支架管，端侧吻合时对应的空肠壁全层切开。

PPJ的平均手术时间12（8~18）min。术后胰瘘（POPF）发生率29.8%（14/47），其中A级胰瘘21.3%（10/47），B级胰瘘8.5%（4/47）。无胰肠吻合口出血，无再次开腹手术和死亡病例。术后门诊随防34例，3个月后CT或MRI检查胰管未见明显扩张。

贯穿缝合式胰肠端侧吻合术操作简单、吻合可靠，可适用于所有的胰腺切断，易于推广应用。

To study a safe, reliable, simpler and commonly used pancreaticojejunal anastomotic method called penetrating-suture pancreaticojejunostomy (PPJ) completely different from any other existing methods in pancreaticoduodenectomy(PD).

From May 2002 to June 2012, a new surgical technique, anastomosis of the pancreas stump and jejunal wall with penetrating-suture technique was performed upon 47 patients in pancreaticoduodenectomy. This new method was based on the new concept that the pancreas stump should be anastomosed to the jejunum in a way as a parenchymatous organ rather than a tubular organ. The full-thickness of the pancreas stump was incorporated with posterior and anterior walls of the jejunum by placing a single needle suture. The entire anastomosis requires only 6-8 sutures. A short stent tube inserted into the pancreatic duct and fixed with a suturing thread was placed through the anastomosis into the jejunum before knot-tying. All layers of the jejunum wall on the corresponding site was cut in the end to side PPJ. The clinical data were reviewed and analyzed.

The median time to perform PPJ was 12 min(ranging from 8 to18 min). The rate of Postoperative Pancreatic Fistula (measured using International Study Group of Pancreatic Fistula definition) was 29.8%(14/47) in all, including grade A 21.3%(10/47), grade B 8.5%(4/47). There was no pancreatic anastomotic leakage and bleeding. There was no reoperation, or mortality among patients in this series. Pancreatic duct patency was confirmed by CT and MRI in 34 patients 3 months after surgery.

The PPJ procedure is effective in avoiding anastomotic leakage and is applicable to all patients in whom the pancreatic duct can be identified.