改良套入式胰肠吻合术与黏膜对胰管胰肠吻合术的回顾性病例对照研究

A retrospective case-control study on postoperative pancreatic fistula about modified invagination pancreaticojejunostomy and mucosa to duct pancreaticojejunostomy

目的对比分析改良套入式胰肠吻合术(MIP)和黏膜对胰管胰肠吻合术(MDP)的临床应用效果。方法回顾性分析首都医科大学附属北京友谊医院普外科2013年1月—2019年1月行胰十二指肠切除术并采用MIP或MDP的222例患者临床资料,根据手术方式,按照性别和年龄段匹配的方法,1∶1分为MIP组(n=111)和MDP组(n=111)观察两组患者胰瘘发病情况。采用SPSS20.0软件进行统计学分析。结果MIP与MDP两组患者均无围手术期死亡。MIP组的平均手术时间较MDP短[(212.8±62.4)min比(231.5±51.9)min,P=0.016],但是术中出血量、输血量、术后恢复排气时间、术后进食流食时间两组差异均无统计学意义(P>0.05)。MIP组无C级胰瘘,MDP组有2例C级胰瘘。但是两组总体胰瘘发生率和胰瘘分级无显著性差异。结论MIP与MDP两种胰肠吻合方法的临床应用效果没有显著差异,前者操作简单、易于学习掌握,有一定的推广价值,但仍需前瞻性对照研究进一步证实。

Objective To compare clinical outcomes between modified invagination pancreaticojejunostomyandmucosa (MIP) to mucosa duct pancreaticojejunostomy(MDP) in pancreaticoduodenectomy. Methods In Department of General Surgery, Beijing Friendship Hospital Capital Medical University, from Jan. 2013 to Jan. 2019, there were 222 cases performed pancreaticoduodenectomy, with MIP or MDP. According to the operation methods, by matching the sex and year decads, all patients were divided into MIP group (n=111) and MDP group (n=111). The incidence of pancreatic fistula in two groups was observed. The software of SPSS 20.0 was adopted for statistical analysis. Results There was no perioperative death in both groups. The mean operative time of MIP group was significant shorter than that of the MDP group [(212.8±62.4) min vs (231.5±51.9) min, P=0.016]. However, there were no significant differences in blood loss, blood transfusion, bowel function recovery and liquid diet time. There was no grade C pancreatic fistula in MIP group, but 2 cases in MDP group. There were no significant differences in incidence and classification of pancreatic fistula between two groups. Conclusions There were no significant differences in clinical outcomes between MIP and MDP. The MIP is more easier to performed, so it is of certain spreading value. However, the further evidence need more prospective controlled study.