交锁套入法胰肠吻合在胰头十二指肠切除术中的价值

Applied value of interlocking invaginated pancreaticoenterostomy after pancreaticoduodenectomy

目的 探讨交锁套入法胰肠吻合在胰十二指肠切除术（PD）的价值.方法 PD 143例分别采取常规套入法PD 75例,交锁套入法PD 68例,分析两种方法间的不同差异,探讨交锁套入法胰肠吻合预防胰漏的价值.结果 两种方法比较,胰肠吻合时间传统法为（35 ±8） min,交锁法为（30 ±5） min,胰肠吻合口测压传统法为（52±12） cmH2O（1 cmH2O=0.098 kPa）,交锁法为（81±24） cmH2O,胰漏传统法为26.7％,交锁法为4.4％,胰漏引流量传统法为（175 ±125） ml,交锁法为（42±12） ml,胰漏愈合时间传统法为（19.6±16.4）d,交锁法为（9.1±1.9）d,腹腔感染传统法为12.0％,交锁法为7.4％,肺部感染传统法为9.3％,交锁法为8.8％,胸腔积液传统法为14.7％,交锁法为8.8％,住院时间传统法为（26.2±11.5）d,交锁法为（20.9±6.0）d,手术死亡率传统法为6.7％,交锁法为2.9％（P＜0.05）.结论 交锁套入法与传统法比较胰肠吻合时间缩短、胰肠吻合口耐受压升高明显、胰漏发生率明显降低、胰漏引流量减少、胰漏愈合时间缩短、并发症下降、住院时间缩短及手术死亡率明显降低.交锁法可预防胰漏.

Objective To investigate the clinical value of interlocking invaginated pancreaticoenterostomy after pancreaticoduodenectomy （PD）.Methods The clinical data of 143 cases of pancreatic head cancer treated with PD were retrospectively analysed.Of these 143 patients,75 underwent conventional pancreaticoenterostomy,and 68 interlocking invaginated PD.The difference between the two procedures and the value of interlocking invaginated pancreaticoenterostomy to prevent pancreatic leakage were analyzed.Results In the conventional pancreaticoenterostomy and interlocking invaginated pancreaticoenterostomy,the operation time was （35 ± 8） min and （30 ± 5） min,the anastomotic pressure was （52 ±12） cmH2O （1 cmH2O =0.098 kPa） and （81 ± 24） cmH2O,the incidence of pancreatic fistula was 26.7% and 4.4%,the pancreatic fistula drainage was （175 ± 125） ml and （42 ± 12） ml,the pncreatic fistula healing time was （19.6 ± 16.4） days and （9.1 ± 1.9） days,the rate of abdominal infection was 12.0% and 7.4%,the incidence of lung infection was 9.3% and 8.8%,the rate of pleural effusion was 14.7% and 8.8%,the hospital stay was （26.2 ± 11.5） days and （20.9 ±6.0） days,and the operative morbidity rate was 6.7% and 2.9%,respectively （P 〈 0.05）.Conclusion The operation time is shortened,the tolerance pressure of the stoma is increased significantly,the incidence of pancreatic leakage is reduced significantly,the pancreatic fistula drainage is decreased,and the pancreatic fistula healing time and hospitalil stay are shortened,and the rate of operative mortality and the occurrence of pancreatic leakage are significantly reduced in the interlocking invaginated pancreaticoenterostomy as compared with conventional pancreaticoenterostomy.