改良胰管空肠端侧黏膜吻合术在胰十二指肠切除术中的应用

Application of modified pancreatic duct-to-jejunal mucosa end-to-side anastomosis in pancreaticoduodenectomy

目的:探讨改良胰管空肠端侧黏膜吻合术在胰十二指肠切除术(PD)中的应用效果。方法:回顾性分析2016年1月—2018年11月在80例行PD术患者的临床资料,其中39例行改良胰管空肠端侧黏膜吻合(改良组),41例行传统胰管空肠端侧黏膜吻合组(传统组),比较两组相关临床指标及术后胰瘘及其他并发症发生情况。结果:两组患者术前一般资料无明显差异(均P>0.05);两组患者手术时间、胰肠吻合时间,腹腔内出血、淋巴漏、胃排空障碍等指标比较差异均无统计学意义(均P>0.05);改良组较传统组胰瘘总发生率明显减少[5.12%(2/39)vs.24.4%(10/41),P<0.05],其中,改良组2例均为生化漏,无B/C级胰瘘,传统组生化漏2例,B/C级胰瘘8例。结论:改良胰管空肠端侧黏膜吻合术较传统胰管空肠端侧黏膜吻合术能明显降低PD术后胰瘘的发生率,有一定的临床应用价值。

Objective:To investigate the clinical efficacy of using modified pancreatic duct-to-jejunal mucosa end-to-side anastomosis in pancreaticoduodenectomy (PD).Methods:The clinical data 80 patients undergoing PD from January 2016 to November 2018 were retrospectively analyzed.Of the patients,39 cases underwent modified pancreatic duct-to-jejunal mucosa end-to-side anastomosis (modified group) and 41 cases underwent traditional pancreatic duct jejunum end-to-side mucosal anastomosis (traditional group).The main clinical variables and the incidence of postoperative pancreatic fistula and other complications were compared between the two groups.Results:There were no significant differences in preoperative data between the two groups (all P>0.05).No significant differences were noted in total operative time and time for pancreaticojejunostomy,as well as the incidence of intra-abdominal hemorrhage,lymphatic leakage and delayed gastric emptying between the two groups (all P>0.05).The total incidence of pancreatic fistula in the modified group was significantly lower than that in traditional group [5.12%(2/39) vs.24.4%(10/41),P<0.05],and in modified group,both cases were biochemical leakage and no B/C pancreatic fistula occurred,while in traditional group,biochemical leakage occurred in 2 cases and B/C pancreatic fistula occurred in 8 cases.Conclusion:Modified pancreatic duct-to-jejunal mucosa end-to-side anastomosis can significantly reduce the incidence of pancreatic fistula after PD compared to traditional procedure.It has certain application value in clinical practice.