三种胰肠吻合方式下两类胰漏的探讨

Investigation of two types of pancreatic fistula occurrence for three types of pancreaticojejunostomy

目的:分析比较胰十二指肠切除术患者三种胰肠吻合方式下两类胰漏发生的差异。方法:对2001年1月至2005年1月期间89例胰十二指肠切除术患者资料进行了回顾性分析研究,依据术中胰肠吻合方式的不同,分为3组:捆绑式胰肠吻合组(A组,n=36)、胰肠端端双层套入吻合组(B组,n=28)和胰肠端侧双层套入吻合组(C组,n=25)。组间胰漏发生例数差异的比较采用多个独立样本秩和检验,P<0.05表示差异有统计学意义。结果:A组无胰漏发生;B组发生胰肠吻合口漏1例(3.2%)、单纯胰腺渗漏5例(17.9%);C组发生胰肠吻合口漏1例(4.0%),单纯胰腺渗漏4例(16.0%)。3组间胰肠吻合口漏发生情况差异无统计学意义(P>0.05)。3组间单纯胰腺渗漏发生情况差异有统计学意义(P<0.05),组间两两比较结果A组显著低于B、C两组(P<0.025),后两组间比较差异无统计学意义(P>0.025)。结论:捆绑式胰肠吻合术可以减少沿缝合针孔渗漏的单纯胰腺渗漏发生机会。胰十二指肠切除术后胰漏的判定和区分,值得进一步探讨和确立。

Objective To investigate the difference of two types of pancreatic fistula occurring in pancreatoduodenectomy patients following three types of pancreaticojejunostomy. Methods Total of 89 medical records were collected and analyzed in the present retrospective study. The patients were divided into three groups according to the different types of pancreaticojejunostomy being administered, which were binding pancreaticoenterostomy group（36 cases）, end-to-end two-layer invaginated pancreaticoenterostomy group（28 cases） and end-to-side two-layer invaginated pancreaticoenterostomy group （25 cases）. Numbers of pancreatic fistula patients for every group was counted and compared by independent samples Kruskal-Wallis analysis using SPSS 11.5 statistical software. Significance was defined as P 〈 0.05. Resdts None and 6 and 5 patients were diagnosed as pancreatic fistula in binding pancreaticoenterostomy, end-to-end two-layer invaginated pancreaticoenterostomy and end-to-side two-layer invaginated pancreaticoenterostomy group, respectively. There were less number of simple pancreatic leakage patients in binding pancreaticoenterostomy group than those of end-to-end two-layer invaginated pancreaticoenterostomy（5 cases） and end-to-side two-layer invaginated pancreaticoenterostomy group （4 cases）, and no significance was conformed between the latter two groups. There was no significance of anastomotic leakage among the three groups （ P 〉 0. 05） . Conclusion The chances of simple pancreatic leakage, from the hole of the suture needle, might be reduced by binding pancreaticoenterostomy. The determination and classification of pancreatic fistula after pancreaticoduodenectomy may be worth investigating and establishing by further studies.