膵空腸吻合、膵空腸吻合術

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/04/08 20:34:32」(JST)

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The Puestow procedure (also known as a Puestow-Gillesby procedure, or a pancreaticojejunostomy) is a surgical technique used in the treatment of chronic pancreatitis. It involves a side-to-side anastomosis of the pancreatic duct and the jejunum.^[1]

Technique

The operation involves creating a longitudinal incision along the pancreas while the main pancreatic duct is filleted open longitudinally from the head of the organ to its tail. The duct and pancreas are then attached to a loop of the small intestine (pancreaticojejunostomy), which is oversewn to the exposed pancreatic duct in order to allow its drainage. When used in the appropriate setting, pain from chronic pancreatitis can improve. One advantage of this procedure compared to a Frey's procedure is that pancreatic tissue is preserved, which may be of critical importance in patients with exocrine or endocrine insufficiency from their chronic pancreatitis.

Indications

A Puestow procedure is indicated for the treatment of symptomatic chronic pancreatitis patients with pancreatic ductal obstruction and a dilated main pancreatic duct. The main pancreatic duct needs to be 6mm in diameter in the body of the pancreas for this procedure to be possible.

Limitations

One of the problems that can lead to failure of the Puestow procedure is that pain can persist due to failure to drain the pancreatic duct on the head of the pancreas. A Frey's procedure is an alternative surgical procedure to the Puestow that allows for better drainage of the head, but pancreatic tissue is removed.

Eponym

It is named for the American surgeon Charles Puestow (1902–1973).^{[citation needed]}

References

^ Howell JG, Johnson LW, Sehon JK, Lee WC (2001). "Surgical management for chronic pancreatitis". The American surgeon 67 (5): 487–90. PMID 11379656.

Additional reading

Bapat RD, Satish R R, Kantharia CV. Choice Of Surgical Procedures for Chronic Pancreatitis. Bombay Hospital Journal. January 2001. Available at: http://www.bhj.org/journal/2001_4301_jan/reviews_175.htm. Accessed on: October 15, 2007.

External links

Puestow's procedure (drawing) - Bombay Hospital Journal.

UpToDate Contents

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1. 慢性膵炎の治療 treatment of chronic pancreatitis
2. 膵管癒合不全の治療 treatment of pancreas divisum
3. 成人における慢性膵炎の病因および発症機序 etiology and pathogenesis of chronic pancreatitis in adults

English Journal

Is the enteral replacement of externally drained pancreatic juice valuable after pancreatoduodenectomy?

Yokoyama Y, Ebata T, Igami T, Sugawara G, Nagino M.Author information Department of Surgery, Division of Surgical Oncology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan, yyoko@med.nagoya-u.ac.jp.AbstractPURPOSES: External drainage of pancreatic juice using a pancreatic duct stent following pancreatoduodenectomy is widely performed. We hypothesized that the replacement of externally drained pancreatic juice would help to prevent postoperative complications, including pancreatic fistulas.
Surgery today.Surg Today.2014 Feb;44(2):252-9. doi: 10.1007/s00595-013-0522-8. Epub 2013 Mar 16.
PURPOSES: External drainage of pancreatic juice using a pancreatic duct stent following pancreatoduodenectomy is widely performed. We hypothesized that the replacement of externally drained pancreatic juice would help to prevent postoperative complications, including pancreatic fistulas.METHODS: Six
PMID 23494105

Pancreatic fistula after a pancreaticoduodenectomy for ductal adenocarcinoma and its association with morbidity: a multicentre study of the French Surgical Association.

Addeo P, Delpero JR, Paye F, Oussoultzoglou E, Fuchshuber PR, Sauvanet A, Sa Cunha A, Le Treut YP, Adham M, Mabrut JY, Chiche L, Bachellier P; French Surgical Association (AFC).Author information Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Hopital de Hautpierre, Université de Strasbourg, Strasbourg, France.AbstractBACKGROUNDS: A pancreatic fistula (PF) is the most relevant complication after a pancreaticoduodenectomy (PD). This retrospective multicentric study attempts to elucidate the risk factors and complications of a PF in a large cohort of patients undergoing a PD for ductal adenocarcinoma.
HPB : the official journal of the International Hepato Pancreato Biliary Association.HPB (Oxford).2014 Jan;16(1):46-55. doi: 10.1111/hpb.12063. Epub 2013 Mar 6.
BACKGROUNDS: A pancreatic fistula (PF) is the most relevant complication after a pancreaticoduodenectomy (PD). This retrospective multicentric study attempts to elucidate the risk factors and complications of a PF in a large cohort of patients undergoing a PD for ductal adenocarcinoma.METHODS: Using
PMID 23461663

Laparoscopic intussuscepting pancreaticojejunostomy.

Hughes SJ, Neichoy B, Behrns KE.Author information Department of Surgery, University of Florida College of Medicine, Gainesville, PO Box 100109, FL, 32610-0109, USA, Steven.hughes@surgery.ufl.edu.AbstractPerhaps the greatest barrier to adoption of laparoscopic pancreaticoduodenectomy by experienced pancreatic surgeons is the technical challenge of constructing the pancreaticojejunostomy (PJ). The authors present a less demanding PJ technique they have developed that creates an end-to-end intussuscepting anastomosis using a running monofilament suture. This method reduces technical complexity and operative time while producing acceptably comparable outcomes.
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract.J Gastrointest Surg.2014 Jan;18(1):208-12. doi: 10.1007/s11605-013-2308-0. Epub 2013 Aug 9.
Perhaps the greatest barrier to adoption of laparoscopic pancreaticoduodenectomy by experienced pancreatic surgeons is the technical challenge of constructing the pancreaticojejunostomy (PJ). The authors present a less demanding PJ technique they have developed that creates an end-to-end intussuscep
PMID 23929187

Japanese Journal

Whereabouts of an internal short stent placed across the pancreaticojejunostomy following pancreatoduodenectomy

Kadowaki Susumu,Miura Fumihiko,Amano Hodaka [他],TOYOTA Naoyuki,WADA Keita,SHIBUYA Makoto,MAENO Sawako,TAKADA Tadahiro,SANO Keiji
Journal of hepato-biliary-pancreatic sciences 19(5), 566-577, 2012-09-01
NAID 10031039481