annular pancreas surgery

The ring-shaped pancreas is a congenital malformation. During embryonic development, because the tip of the ventral pancreatic primordium is fixed, it cannot rotate to the left along with the duodenum and there is a band of pancreatic tissue, partially or complete the first or second segment of the duodenum. , causing intestinal stenosis leads to a series of clinical signs. Treating diseases: ring pancreas Indication Ring-shaped pancreas is asymptomatic and does not require treatment. If it causes duodenal stenosis and obstruction, it is suitable for surgical treatment. Contraindications Older, combined with severe heart, liver, kidney and other diseases and difficult to tolerate surgery. Preoperative preparation The operation of the ring-shaped pancreas is more complicated. Moreover, such patients have a long history, large body consumption, and low nutrition. Therefore, adequate conditioning should be given to correct the imbalance of water and electrolytes, antibiotics, blood preparation, and surgery. Wash the stomach and lower the stomach tube the night before. Surgical procedure 1. Position, incision: supine position. The median incision in the upper abdomen or the right upper rectus abdominis incision. 2. Exploration: After entering the abdominal cavity, firstly identify the site of duodenal stenosis and obstruction, and further discover that it is a complete annular pancreatic or incomplete annular pancreas. It is also necessary to check the common bile duct and gallbladder. Changes in the device. Careful exploration is the premise of which procedure to choose. 3. Surgical methods (1) Annular pancreatectomy: If the annular pancreatic tissue is thin, the blood vessels are not distributed, and the intestinal wall is not tightly attached. The annular pancreas can be partially or completely removed to relieve the intestinal obstruction or add duodenal longitudinal. The transverse incision is sutured to enlarge the duodenal lumen. The shortcomings of this procedure are the production of pancreatic fistula, duodenal fistula and pancreatic cysts, and postoperative duodenal stenosis or obstruction cannot be completely relieved, and surgery is required. Therefore, the effect is not as good as the shortcut diversion surgery. (2) shortcut surgery 1) simple gastrojejunostomy: more commonly used in adult cases, but must be combined with vagus nerve resection, otherwise anastomotic ulcer is prone to occur. Or the first gastro-intestinal resection, followed by gastrojejunostomy, that is, Piro ii surgery, is also an ideal method. 2) duodenal jejunostomy: a jejunum 15 to 20 cm from the duodenal suspensory ligament in the transverse colon, laterally anastomosis to the proximal duodenal descending segment of the obstruction. This operation is simple and effective in relieving obstruction. More suitable for children. 3) duodenum and duodenal anastomosis: first cut the peritoneum on the lateral side of the duodenum, separate the obstructed duodenum, and then make a two-needle pull line on the anterior wall of the proximal part of the obstruction In the anterior wall of the obstruction proximal to the intestine, a two-needle traction line is also used. A transverse incision is made in the proximal intestinal wall of the obstruction, and a longitudinal incision is made in the distal intestinal wall. The first-line anastomosis is performed with a No. 1 silk thread, and a single-layer intestinal wall is feasible. Anastomosis, needle spacing of 2mm is appropriate. This method is more physiological and suitable for neonatal and infant cases. In the case of obstruction of the lower common bile duct, in addition to the obstruction of the duodenum, the obstruction of the biliary tract must be removed, and the common bile duct and the duodenal obstruction are adjunctive. complication Gastrointestinal pressure is high.