不同胰肠吻合方式在胰十二指肠切除术中临床效果的比较

Comparison of clinical effects of different methods of intestinal anastomosis in patients with pancreatic and duodenal resection

目的比较和探讨端端胰肠套入式吻合、捆绑式胰肠吻合、端侧胰肠套人式吻合、改良胰管空肠黏膜端侧吻四种吻合方式的临床应用效果。方法收集胰十二指肠切除患者95例，其中端端胰肠套入式吻合23例、捆绑式胰肠吻合18例、端侧胰肠套入式吻合28例、改良胰管空肠黏膜端侧吻合26例，比较四组患者胰肠吻合时间、术后并发症发生情况。结果吻合时间：A组（34．0±4．6）min，13组（31．0±5．8）min，C组（32．0±6．3）min，D组（14．0±4．2）min，（P=0．037）。术后胰瘘、胆漏、腹腔或消化道出血发生率差异无统计学意义（P〉0．05）。改良胰管空肠黏膜端侧吻合胰瘘的发生率低，但不同胰肠吻合方式胰瘘发生率差异无统计学意义，改良胰管空肠黏膜端侧吻合组胰肠吻合时间明显短于其三组，差异有统计学意义（P〈0．05）。结论改良胰管空肠黏膜端侧吻合手术时间短，胰瘘的发生率低，并且操作简单、实用，安全。

Objective To compare and discuss the clinical application effect of the end - to - end anastomosis of pancreatic and intestinal anastomosis, binding type of pancreatic and intestinal anastomosis, end - to side pancreatic duct anastomosis and modified pancreatic duct jejunum anastomosis. Methods Collected panereatoduodenectomy in 95 cases, the end - to - end pancreatico duodenal sleeve type anastomosis in 23 cases, binding type pancreatic enteric anastomosis in 18 cases, end to side panereaticojejunostomy anastomosis in 28 cases, improvement of the pancreatic duct jejunum end to side anastomosis in 26 cases, compared with four groups of patients with pancreatic enteric anastomosis time and postoperative complications. Results Anastomosis time ： A group （ 34.0 ± 4.6 ） min, B group （31.0±5.8） min,C group （32.0±5.3） min,D group （14.0 ±4.2） min（P=0.037,P〈0.05）.And the incidence rate of postoperative pancreatic fistula, bile leakage, abdominal cavity or digestive tract bleeding had no significant difference （ P 〉 0.05 ）. Improvement of the pancreatic tube jejunum end to side coincident with a low incidence of pancreatic fistula, but different pancreatic enteric anastomosis way pancreatic fistula rate difference was not statistically significant,improvement of the pancreatic duct and jejunum mucosa end side group pancreatic enteric anastomosis anastomosis time significantly shorter in the three groups,the difference was statistically significant （P 〈 0.05 ）. Conclusion Improvement of pancreatic duct jejunum end to side anastomosis with short operation time,low incidence of pancreatic fistula, and the operation is simple and practical ,safe.