[Experimental and clinical studies on operative methods of pancreaticojejunostomy in reference to the process of wound healing and postoperative pancreatic function].

After pancreaticoduodenectomy, the duct of residual pancreas is treated with ligation or anastomosed to jejunum. This study was carried out to determine whether or not pancreaticojejunostomy is necessary and if necessary, attempt was followed what kind of anastomosis is ideal from the view of wound healing, and reserving exocrine and endocrine function of the residual pancreas. Necessity for pancreaticojejunostomy: Forty mongrel dogs were divided into two groups: Group 1: Complete ligation of the pancreatic duct without anastomosis between the pancreas and jejunum. Group 2: Anastomosis between the jejunum and fibrotic pancreas which was caused by ligation of the pancreatic duct for three weeks. As results, even in fibrotic pancreas, pancreaticojejunostomy should be done after pancreaticoduodenectomy, to preserve exocrine and endocrine function of the residual pancreas. Operative methods of pancreaticojejunostomy: One hundred and twenty mongrel dogs were used to evaluate three kinds of pancreaticojejunostomy in terms of microangiography, hydroxyproline content, histopathological findings, bursting strength of the anastomotic site and incidence of anastomotic leakage. Pancreatic function was assessed by intravenous glucose tolerance test and pancreozymin secretin test. The best results were obtained by the anastomosis between mucosa of jejunum and pancreatic duct. Clinical application: The method of the anastomosis between the mucosa of the jejunum and pancreatic duct was applied to 142 patients with periampullary cancer from January 1971 to December 1982 at Keio University Hospital. Pancreatic leakage was seen in 10% (5/50) of patients with normal pancreatic tissue without pancreatic duct obstruction and did not occur in 40 patients with fibrotic pancreas.