根据胰管直径等因素选择不同胰肠吻合方式对患者术后恢复的影响

Effect of pancreaticojejunostomy based on factors such as diameter of the pancreatic duct on postoperative recovery

目的评价根据胰管直径等因素选择的不同胰肠吻合方式对患者术后恢复的影响,为胰肠吻合方式的选择决策提供依据。方法回顾性分析我院在2010年1月至2013年1月间行胰十二指肠切除术305例患者的临床资料。对于胰管直径≥3 mm的患者采用胰管空肠黏膜吻合(胰管空肠吻合组,120例);对于胰管直径<3 mm者,进一步比较胰腺残端与空肠管径的直径大小,若胰腺残端较粗大,且大于空肠管径者采用改良Child胰肠吻合(改良Child胰肠吻合组,80例),若胰腺残端直径小于空肠管径者选择捆绑式胰肠吻合(捆绑式胰肠吻合组,105例)。比较不同胰肠吻合方式术后并发症的发生率,评价临床疗效。结果胰管空肠黏膜吻合组胰管直径显著大于其他两组(P<0.05),改良Child胰肠吻合组胰腺残端直径明显大于捆绑式胰肠吻合组(P<0.05)。本组研究总体胰瘘发生率为11.1%(34/305)。比较三组患者术后胰瘘、腹腔出血、腹腔感染、消化功能异常、平均住院时间及术后死亡,差异无统计学意义(x2=1.51,2.78,1.16,3.75,1.94,F=2.13,P>0.05)。结论在行胰十二指肠切除术时,可以根据胰管直径、胰腺残端直径及空肠管径合理选择不同的胰肠吻合方式。

Objective To evaluate the effect of pancreaticojejunostomy procedure based on factors such as diameter of the pancreatic duct on postoperative recovery.Methods The clinical data of 305 cases who received pancreaticoduodenetomy in our hospital from Jan.2010 to Jan.2013 were retrospectively analyzed.For patients with pancreatic duct diameter ≥ 3 mm,duct-to-mucosa pancreaticojejunostomy was applied （120 cases）.For patients with pancreatic duct diameter 〈3 mm,modified Child pancreaticojejunostomy was applied to 80 cases whose pancreatic stump was bigger than or equal to the jejunal end.Binding pancreaticojejunostomy was applied to 105 cases whose pancreatic stump was smaller than the jejunal end.The clinical efficacy and incidence of postoperative complications were compared among the three groups.The count data and measurement data were analyzed by chi-square test and t test,respectively.Results The pancreatic duct diameter of duct-to-mucosa pancreaticojejunostomy group was significantly bigger than that of other two groups （P〈0.05）.The diameter of the pancreatic stump of the modified Child group was significantly bigger than that of binding group （P〈0.05）.The overall incidence of pancreatic fistula was 11.1% （34/305）.There were no significant differences in the incidences of pancreatic fistula,peritoneal bleeding,abdominal infection,digestive dysfunction rate,the mean duration of hospitalization and the death cases among the three groups （χ^2=1.51,2.78,1.16,3.75,1.94,F=2.13,P〉 0.05）.Conclusion Pancreaticojejunostomy procedure selection strategy based on the diameters of pancreatic duct and pancreatic stump could obtain good clinical efficacy and which is appropriate.