生物膜包裹残端预防胰腺远端切除术后胰漏的实验研究

Bovine pericardium wrapping pancreatic stump for prevention of pancreatic leak after distalpancreatectomy

目的探讨猪胰腺远端切除后牛心包生物膜包裹残端对术后胰漏的预防作用，评价该材料在胰腺手术中应用的安全性及可行性。方法小型猪32只随机分成对照组（n=16）与实验组（n=16），2组均接受胰腺远端切除手术，对照组远端胰腺切除后采用传统的单纯手工缝合法，实验组则先用牛心包生物膜包裹住胰腺残端，用同样缝线穿过被裹住的胰腺组织后手工缝合；测定各组术后每日腹腔引流量及引流液淀粉酶水平至术后第10天，判断胰漏情况；术后3周处死动物，观察腹内情况并取残端胰腺组织作病理学检查。结果实验组胰漏率低于对照组（6．2％比46．7％，P〈0．05），术后引流量实验组低于对照组（25．1ml比54．2ml，P〈0．01），术后3周剖腹探查，两组实验动物未见明显差异；胰腺残端组织病理结果两组均显示炎症细胞浸润并伴有少许坏死组织。结论胰腺远端切除术后，利用牛心包生物膜包裹残端后缝合可有效减少术后胰漏的发生，是安全可行的。

Objective To evaluate the safety and efficacy of bovine pericardium wrapping stump after distal pancreatectomy in a porcine model. Methods Thirty-two swine were randomly assigned to control group （n = 16, conventional scalpel transection with hand-sewn closure of the pancreatic remnant） and experiment group （n = 16, bovine pericardium wrapping stump combined with hand-sewn）. Closed- suction drainage was collected daily until the tenth postoperative day. Animals were killed for necropsy at 3 weeks postoperatively and the pancreatic remnant was sampled for histology. Results The incidence of pancreatic leak in the wrapping group was lower than that in the control group （6. 2 vs. 46. 7%, P 〈0. 05）. The amount of drainage fluid was higher in the control group during the postoperative period （ 25. 1 ml vs. 54. 2 ml,P 〈0. 01 ）. There were no differences in operative time or other clinical parameters measured. No other significant differences were found in macroscopic changes between the two groups. Histology demonstrated focal, chronic inflammation with necrosis at the stump in all animals. Conclusions Bovine pericardium wrapping stump effectively reduced the incidence of pancreatic leakage after distal pancreatectomy.