不同胰肠吻合方式胰十二指肠切除术后胰瘘发生率比较

The incidence of pancreatic fistula after pancreaticoduodenectomy with different ways of pancreatic anastomosis in 540 patients

目的:分析不同胰肠吻合方式胰十二指肠切除术(pancreaticoduodenectomy,PD)后胰瘘发生情况,探讨胰瘘发生的主要原因。方法:总结我院1994年8月至2012年12月18年间540例胰十二指肠切除术后胰瘘的发生情况,按3种不同胰肠吻合方式进行分组,其中采用单纯套入吻合32例为A组;采用胰管空肠黏膜对端吻合363例为B组;套入加捆绑式胰肠吻合145例为C组,胰瘘的定义参照国际胰瘘研究组(ISGPF)诊断标准。结果:胰瘘总发生率为6.5%,其中A组为28.1%,B组为5.8%,C组为3.4%;总手术死亡率为2.0%,A组为21.9%,B组为0.8%,C组为0.7%,在发生胰瘘的病例中,A组主要为C级瘘,B、C组主要为A、B级瘘,胰瘘发生率A组与B组间差异显著(χ2=17.85,P=0.00),A组与C组间差异同样显著(χ2=18.65,P=0.00),B组与C组间差异无统计学意义(χ2=1.165,P=0.28)。结论:胰肠吻合方式的改进与完善以及熟练的手术技巧是降低胰瘘发生率的主要因素,加强手术前后综合治疗是防止胰瘘的重要保障。

Objective To analyze the incidence of pancreatic fistula after pancreaticoduodenectomy （PD） with different ways of pancreatic anastomosis, and to discuss the main causes of pancreatic fistula. Methods The incidence of pancreatic fistula after PD in 540 patients from Aug 1994 to Dec 2012 was summarized. All 540 patients were divided into 3 groups according to the ways of pancreatic anastomosis： Patients in Group A （n = 32） received the simple set of in line, those in Group B （n = 363） received pancreatic duct jejunum mucosa to side anastomosis, and those in Group C （n = 145） received simple set of in line and pancreatic anastomosis. Pancreatic fistula was defined by the international research team （ISGPF） diagnostic criteria. Results The total incidence of pancreatic fistula was 6.5%; and that in Group A was 28.1%, in Group B was 5.8%, and in Group C was 3.4%. Total surgical mortality was 2.0%; and that in Group A was 21.9%, in Group B was 0.8%, in Group C was 0.7%. In the patients with pancreatic fistula, C-class fistula was the main in Group A, and A- and B-class were the main in Group B and C. The incidence of pancreatic fistula was significantly different between Group A and Group B （X^2 = 17.85, P= 0.00）, and between Group A and Group C （X^2 = 18.65, P= 0.00）; and was not significant different between Group B and Group C （X^2 = 1.165, P = 0.28）. Conclusions Improvement and perfection of ways of pancreatic anastomosis, and skillful surgical techniques were the main factor in reducing the incidence of pancreatic fistula; strengthen the comprehensive treatment before and after operation was an important guarantee to prevent pancreatic fistula.