“黏膜优先愈合”理论指导下的胰管空肠吻合术

Pancreaticojejunostomy guided by the theory of mucosal priority healing

摘要:

胰肠吻合术是胰十二指肠切除术中的关键环节，其质量直接影响术后胰瘘及出血等并发症的发生。尽管相关技术不断改进，术后发生严重并发症风险仍然较高。基于病理切片观察及组织学分析，结合肠黏膜爬行修复特点，笔者提出“黏膜优先愈合”理论，即通过缩短肠黏膜爬行距离、减少吻合口缝合针数，促进肠黏膜与胰管上皮的快速对接与修复。在该理论指导下优化的胰管空肠吻合术，在保证胰液引流通畅的同时，有助于降低术后出血、再手术及死亡等严重并发症发生风险。本文系统阐述该理论的形成依据、技术要点及临床应用效果，并结合国内外研究进展，对其发展前景进行探讨，以期为胰肠吻合术的规范化与精准化提供参考。

Abstract:

Pancreaticojejunostomy is a critical step in pancreatoduodenectomy, and its quality directly affects the incidence of postoperative complications, including pancreatic fistula and hemorrhage. Despite continuous technical improvements, the risk of severe complications remains substantial. Based on pathological observations and histological analyses, and considering the migration characteristics of intestinal mucosa, we propose the concept of "mucosal priority healing". This concept emphasizes shortening the migration distance of intestinal mucosa and reducing the number of anastomotic sutures to facilitate rapid apposition and healing between the jejunal mucosa and the pancreatic duct epithelium. Pancreaticojejunostomy guided by this concept optimizes the healing mechanism of the anastomosis, ensures adequate pancreatic drainage, and may reduce the risk of severe complications such as postoperative hemorrhage, reoperation, and mortality. This article systematically reviews the theoretical basis, technical features, and clinical outcomes of this approach, and discusses future research directions in the context of current evidence, aiming to provide insights into the standardization and precision of pancreaticojejunostomy.