不同胰肠吻合方式的临床效果比较

Comparison of the efficacy of different methods of pancreaticojejunostomy

目的:探讨端端胰肠套入式吻合、端侧胰管空肠黏膜吻合和捆绑式胰肠吻合的临床应用效果.方法:收集本院1999-02/2009-05行胰十二指肠切除术的患者资料157例,其中采用端端胰肠套入式吻合方式61例,端侧胰管空肠黏膜吻合方式66例,捆绑式胰肠吻合方式30例.分析患者胰肠吻合时间、术后并发症各指标、死亡率及住院时间.结果:端端胰肠套入式吻合时间、端侧胰管空肠黏膜吻合时间与捆绑式胰肠吻合组比较差异有统计学意义(35.85±4.73min,37.18±6.12min vs20.75±4.05min,均P<0.05).3组术后并发症各指标、死亡率及住院时间统计学上无差异.捆绑式胰肠吻合无1例发生胰漏.结论:3种方法均有良好的临床效果及较低的并发症.捆绑式胰肠吻合具有操作更方便、手术时间短、并发症少的优点,值得临床推广.

AIM： To compare the efficacy of end-to-end invaginated pancreaticojejunostomy, duct-tomucosa pancreaticojejunostomy and binding pancreaticojejunostomy. METHODS： The clinical data of 157 patient who underwent pancreaticoduodenectomy at our hospital from February 1999 to May 2009 were collected. Of all patients, 61 underwent endto-end invaginated pancreaticojejunostomy, 66 underwent duct-to-mucosa pancreaticojejunostomy and 30 underwent binding pancreaticojejunostomy. The anastomotic time, postoperative complications, death rate and length of stay were compared.RESULTS： The mean time to complete end-toend invaginated pancreaticojejunostomy, ductto-mucosa pancreaticojejunostomy and binding pancreaticojejunostomy was 35.85 ± 4.73, 37.18 ± 6.12 and 20.75 ± 4.05 min, respectively. The mean time to complete binding pancreaticojejunostomy was significantly shorter than that to complete end-to-end invaginated pancreaticojejunostomy and duct-to-mucosa pancreaticojejunostomy （both P 0.05）. No significant differences were noted in complication rate, mortality rate and length of stay among the three groups. No pancreatic leakage was observed after binding pancreaticojejunostomy. CONCLUSION： Satisfactory efficacy and low complication rate can be achieved using any of the three methods of pancreaticojejunostomy. Binding pancreaticojejunostomy has more convenient procedure, shorter operative time and less complications than the other two methods.