胰肠吻合术缝线的改进和疗效观察

目的总结胰十二指肠切除术胰肠吻合缝线的改进及成功经验。方法回顾性研究2001年6月～2008年6月施行胰十二指肠切除术76例,男48例,女28例,平均年龄51.3岁(32～74岁)。其中胰头癌34例,胆管下段癌16例,十二指肠乳头癌18例,胰岛细胞癌4例,胰头囊腺瘤4例。胰肠吻合采用黏膜对黏膜胰管空肠端侧吻合,第一层胰管粘膜对空肠粘膜均匀缝合4针,第二层空肠浆肌层对胰腺断面间断缝合,尽量贴合胰腺断面不留死腔,第三层空肠浆肌层对胰腺包膜连续缝合。手术缝线改进为:将胰肠端侧粘膜吻合缝线由慕丝缝线改为普理灵缝线。比较胰肠吻合术采用缝线的改进前后对术后并发胰漏的影响。结果术后胰漏总发生率22.37%(17/76),慕丝缝线组27.50%(11/40),普理灵缝线组16.66%(6/36)。普理灵缝线组胰漏的发生率显著低于慕丝缝线组(P<0.05)。平均手术时间240min(220～280),慕丝缝线组手术时间230min(210～275),普里灵缝线组手术时间251min(229～290),两组手术时间无显著性差异(P>0.05)。结论胰十二指肠切除术中胰肠吻合改用不可吸收的普理灵可以有效地减少术后胰漏的发生,并没有显著地延长手术时间。

Objective To introduce our experience of the Pancreaticoenterostomy with a modified suture. Methods From Jun 2001 to Jun 2008,76 cases,48 males and 28 femals,with a mean age of 51.3 years（rang： 32-74）,were treated by duodenopancreatectomy in our department. 34 cases of pancreatic carcinoma, 16 cases of cholangiocarcinoma, 18 cases of duodenum papilla carcinoma, 4 cases of Islet cell carcinoma, 4 cases of pancreatic cystadenoma. The improvement included： Pancreaticoenterostomy were done with prolene suture instead of mersilene suture. Sutures as potential risk factors of pancreatic leakage after Pancreaticoenterostomy were statistically studied. Results Of 76 patients the overall rate of pancreatic leakage was 22.37% （17/76）,mersilene group 27.50% （11/40）, prolene group 16.66% （6/36）.The incidenceof pancreatic leakage in patients with prolene suture was significantly lower than in patients with mersilene（P〈 0.05）. Operating procedure with prolene suture didn＇t take more time than that with mersilene suture（P〉0.05）. Conclusion The improvement of suture in Pancreaticoenterostomy was helpful in decreasing the incidence of pancreatic leakage after surgery while it didn＇t take more time for operating procedure.