胰十二指肠切除改良胰管空肠吻合预防胰瘘的临床研究

Clinical Study on Improvement of Pancreatoduodenectomy of Pancreatic Duct Jejunal Anastomosis to Prevent Pancreatic Fistula

目的探讨胰十二指肠切除术改良的胰管空肠端侧黏膜对黏膜胰管空肠套入式吻合方式预防胰瘘的临床应用价值。方法回顾性分析111例胰十二指肠切除术患者的临床资料,其中残胰重建方式为胰管空肠黏膜对黏膜套入式端侧精确吻合(改良胰管空肠吻合)者41例(改良组),胰空肠端端常规套入吻合手术者70例(常规组),比较两种胰肠吻合方法对术后胰瘘发生率的影响。结果改良组41例术后恢复顺利,无一例发生胰瘘;常规组发生胰瘘13例(18.57%)。两种术式间胰瘘发生率差异有统计学意义(P<0.05)。2组其他并发症发生率如消化道出血、胃排空障碍、胆瘘、腹腔感染、肺感染和切口感染以及生存率方面的差异均无统计学意义(P>0.05)。结论胰十二指肠切除术胰管空肠端侧黏膜对黏膜套入式吻合在预防胰瘘发生方面具有明显优势,值得在临床工作中推广运用。

Objective To explore the clinical value of the improved style of pancreatodeodenectomy.Methods Retrospective analysis the data of 111 cases of pancreatodeodenectomy.Forty-one cases of 111 cases were performed the modified Whipple pancreatic jejunal anastomosis,which reconstruction residual pancreatic duct jejunum into the intestinal mucosa sets of accurate end to side anastomosis type（modified group）.Another 70 cases were performed the conventional Whipple pancreatic jejunal anastomosis,which classic lines set into the pancreas jejunum anastomosis（conventional group）.The incidence rate of pancreatic fistula after operation were compared in two groups.Results The postoperative recovery in modified group was smooth,and there was no case of pancreatic fistula.Thirteen cases（18.57%） had pancreatic fistula in conventional group.The difference of incidence rate of pancreatic fistula between two groups was statistically significant（P〈0.05）.The difference in other complications such as gastrointestinal bleeding,delayed gastric emptying,biliary fistula,abdominal infection,lung infection,and wound infection were no statistically significant（P〉0.05）,and the difference of survival rate was also no statistically significant（P〉0.05） in two groups.Conclusions Pancreatic duct jejunum end to side into the mucous membrane of the mucosal anastomosis sets of pancreatodeodenectomy can significantly prevent pancreatic fistula,it is worth to promote the use in clinical work.