胰肠吻合与双荷包胰胃吻合近期临床疗效比较

A comparative study of pancreaticojejunostomy versus double purse-string embedded pancreaticogastrostomy following pancreaticoduodenectomy

目的比较胰十二指肠切除术中运用胰肠吻合与双荷包胰胃吻合的近期疗效，探讨胰肠吻合和双荷包胰胃吻合在胰十二指肠切除术中的合理性选择。方法回顾性该院2010年1月至2012年12月间38例行胰十二指肠切除术患者的临床资料。其中采用胰肠吻合12例，双荷包胰胃吻合26例。结果38例患者手术均顺利完成。双荷包胰胃吻合组胰瘘发生率（0％）、手术时间[（327．50±32．56）min]、术后住院天数[（10．31±2．44）d]显著少于胰肠吻合组[分别为3／12、（425．83±33．77）min和（14．33±4．14）d]，差异有统计学意义（P〈0．05）。胆漏、术后腹腔出血、胃排空延迟、切口感染、肺部感染发生率以及术中出血量虽然亦低于胰肠吻合组，但差异无统计学意义。结论双荷包胰胃吻合是较胰肠吻合相对安全合理的消化道重建方式。前者操作简便，手术时间短，在近期疗效上对预防术后胰瘘等并发症具有很大优越性。

Objective To explore the rationality of pancreaticojejunostomy and double purse embedded pancreaticogastrostomy in pancreaticoduodenectomy through comparing the short-term effects between pancreaticojejunostomy and double purse embedded pancreaticogastrostomy in pancreaticoduodenectomy. Methods A retrospective review was performed for 38 patients who were under went pancreaticoduodenectomy at the second affiliated hospital of Kunming Medical University from January 2010 to December 2012. Results All 38 pancreaticoduodenectomy were performed successfully. The pancreatic fistula （0%）, operationtime [（327.50±32.56） mini, postoperative hospital days [（10.31±2.44） d] were found to be significantly lower in double purse embedded pancreaticogastrostomy group than those of pancreaticojejunostomy group [3/12, （425.83 ± 33.77） rain, （14.33 ± 4.14） d], which has statistical significance（P〈0.06）. Although the incidence of bile leakage, postoperative abdominal bleeding, delayed gastric emptying, infection of incision,infection of lung, intraoperative amount of bleeding are also lower than that of pancreaticojejunostomy group, which has no statistical significance. Conclusions Double purse embedded pancreaticogastrostomy is a digestive tract reconstruction which is safer and more reasonable than pancreaticojejunostomy. The former one is operated simply and the operation time is shorter. There are great advantages in the prevention of corn plications such as pancreatic fistula after pancreaticoduodenectomy.