两种胰肠吻合方式对胰十二指肠切除术后并发症的影响

Effects of two styles of pancreaticojejunostomy following pancreaticoduodenectomy on postoperativecomplications

目的分析胰十二指肠切除术后胰管空肠黏膜对黏膜吻合和套入式胰肠端端吻合术后并发症发生情况，为选择最佳的胰肠重建方式提供依据。方法回顾性分析2004年6月至2008年5月于四川大学华西医院接受胰十二指肠切除术的342例患者的临床资料。根据吻合方式的不同将患者分为黏膜一黏膜吻合组（179例），采用胰管空肠黏膜对黏膜吻合；套入式吻合组（163例），采用套入式胰肠端端吻合。根据Clavien术后并发症诊断和分级标准分析胰管空肠黏膜对黏膜吻合和套人式胰肠端端吻合与术后并发症发生率及其严重程度的关系。计量资料采用t检验，计数资料采用Ⅳ。检验。结果本组患者术后总体并发症发生率为48．8％（167／342），其中黏膜一黏膜组术后并发症发生率为38．0％（68／179），套入式吻合组为60．7％（99／163），两组比较，差异有统计学意义（X2=17．667，P〈0．05）。在术后并发症的严重程度分级中，黏膜一黏膜组患者Ⅱ级和V级并发症发生率分别为16．8％（30／179）和1．1％（2／179），显著低于套入式吻合组的28．2％（46／163）和5．5％（9／163），两组比较，差异有统计学意义（X2=6．484，5．316，P〈0．05）。结论胰十二指肠切除术采用胰管空肠黏膜对黏膜吻合的术后并发症发生率显著低于套入式胰肠端端吻合，胰管空肠黏膜对黏膜吻合可能更有利于患者术后的恢复。

Objective To analyze postoperative complications of duct-to-mucosa pancreaticojejunostomy and side-to-end or end-to-end panereatieojejunostomy following panereaticoduodenectomy. Methods The clinical data of 342 patients who underwent panereatieoduodeneetomy al the West China Hospital of Sichuan University from June 2004 to May 2008 were retrospectively analyzed. All patients were divided into the duct-to-mucosa group （179 cases） and side-to-end or end-to-end group （163 cases） according to the styles of pancreaticojejunostomy. The relationship between the incidence and severity of postoperative complications of the 2 anastomotie styles were analyzed according to the Clavien grading system. The measurement data and the count data were analyzed using the t test or ehi-square test. Results The overall complication rate was 48.8% （167/342） , and the complication rate was 38.0% （68/179） in the side-to-end group and 60.7% （99/163） in the side-to-end or end-to-end group, with a significant difference between the 2 groups （X2= 17. 667, P 〈0.05）. The incidences of grade II and grade V complications were 16.8% （30/179） and 1.1% （2/179） in the duct-to-mucosa group, which were significantly lower than 28.2% （46/163） and 5.5% （9/163） of the side-to-end or end-to-end group （X2= 6. 484, 5. 316, P 〈 0.05）. Conclusion Compared with side-to-end or end-to-end panereaticojejunostomy, duct-to-mucosa panereati- eojejunostomy is a better style with a lower incidence of postoperative complication.