胰肠端侧吻合应用桥袢式引流术临床应用效果

The Efficacy of External Drainage Using Bridge-shaped Drainage Tube in End-to-side Pancreaticojejunostomy

探讨胰肠端侧吻合应用桥袢式引流术临床应用效果。方法收集本院2008年6月～2010年12月期间行胰十二指肠切除术78例,其中A组胰肠端侧吻合应用桥袢式引流术21例,B组胰肠端侧吻合胰管内固定支架外引流术27例,C组胰肠端侧吻合术30例。比较三组胰肠吻合时间、腹腔引流管拔管时间、术后住院天数、胰瘘率。结果 A组患者胰肠吻合时间(23.71±1.71)min,B组为(33.78±2.45)min,C组为(31.70±2.45)min,A组与B、C两组吻合时间分别比较均有统计学差异(P<0.05)。A组拔管时间(6.86±1.06)d,B组(8.32±2.26)d,C组(9.89±2.06)d,A组与B、C两组分别比较均有统计学差异(P<0.05)。A组术后住院时间(14.43±3.53)d,B组(16.76±3.87)d,C组(18.07±3.83)d,A组与B、C两组分别比较,均有统计学差异(P<0.05)。A组胰瘘未发生,B组胰瘘率为3.7%(1/27),C组为10%(3/30),A与B、C两组分别比较无统计学差异。结论胰肠吻合时应用桥袢式引流术设计合理,操作相对简单,手术时间短,能减少腹腔引流管拔管时间,缩短住院天数,对术后胰瘘发生在一定程度上具有预防作用。

Objective To explore the efficacy of external drainage using bridge-shaped drainage tube in end-to-side pancreaticojejunostomy.Methods The clinical data of 78 patients who underwent pancreaticojejunostomy at our hospital from June 2008 to December 2010 were collected.Of all patients,21 underwent external drainage using bridge-shaped abdominal drainage tube in end-to-side pancreaticojejunostomy were divided to A group,27 underwent external drainage using internal fixed frame to pancreatic duct in end-to-side pancreaticojejunostomy were divided to B group and 30 underwent simple end-to-side pancreaticojejunostomy were divided to C group.Results The mean anastomotic time of group A,B and C was（23.71±1.71）min,（33.78±2.45）min and（31.70±2.45） min respectively（P0.05）.The drainage tube extubation time in these three group was（6.86±1.06）days,（8.32±2.26） days and（9.89±2.06）days（P0.05）.The mean hospital stay was（14.43±3.53） days,（16.76±3.87） days and（18.07±3.83） days（P0.05）.The pancreatic fistula rate in these three group was 0,3.7% and 10%.Conclusions Satisfactory efficacy can be achieved by the method of external drainage using bridge-shaped drainage tube in end-to-side pancreaticojejunostomy.It has superiorities of more convenient procedure,shorter operative time,shorter drainage tube extubation time,shorter hospital stay and potentially less pancreatic fistula rate.