空肠减压预防胰十二指肠切除术后胰漏的疗效分析

The application of jejunum decompression in prevention of pancreatic fistula after pancreaticoduodenectomy

目的 探讨空肠减压对胰十二指肠切除（PD）术后胰漏发生率的影响.方法 回顾性分析我科2008年5月至2012年11月432例行PD术患者的临床资料,分为三组：胰肠吻合行空肠减压（空肠减压组）265例,行胰管支架内引流（内引流组）123例,行胰管支架外引流（外引流组）44例.结果 术后胰漏发生率：空肠减压组（6.0％）较内引流组（13.8％）低,差异有统计学意义（P＜0.05）;但与外引流组（11.4％）比,差异无统计学意义（P＞ 0.05）.日均消化液引流量：空肠减压组术后5d后（95±33）mL/d较该组术后1～5d的引流量（388±130） mL/d,亦较术后5d外引流组的引流量（405±136） mL/d少,差异有统计学意义（P＜ 0.05）.结论 空肠减压可以减少PD术后早期空肠上段液体潴留,对预防胰漏起到一定作用;在患者胃肠功能恢复后（术后＞5d）消化液丢失空肠减压组较胰液外引流组少,有利于术后恢复;胰十二指肠切除术中空肠减压为一种安全的手术方式.

Objective To investigate the effect of jejunum decomprecssion in prevention of pancreatic fistulaand its complications after pancreaticoduodenectomy. Methods The clinical data of 432 patients who underwent pancreaticoduodenectomy from May 2008 to Nov. 2012 were retrospectively analyzed. The jejunum cavity drainage was used in 265 cases, internal drainage of pancreatic duct was stented in 123 cases, and external drainage of pancreatic duct was stented in 44 cases. Results The incidence of postoperative pancreatic leakage： compared with the internal drainage group （13.8%）, incidence of pancreatic leakage in jejunum cavity drainage group （6.0%） was lower （P〈0.05）, and that in the external drainage group was 11.4% （P〉0.05）. The daily drainage volume of digestive juice： in the jejunum cavity drainage group, compared with the drainage volume within 5 d （388 ± 130） mldd and external drainage volume after 5 d （405±136） mL/d postoperatively, the drainage volume declined after 5 d （95 ±33） mL/d, which showed statistically significant difference （P〈0.05）. Conclusion Jejunum cavity drainage can reduce the upper jejunum fluid retention in the early stage after PD, it has certain effect for the prevention of pancreatic leakage. Compared with the stented external drainage group, patients in the jejunum cavity drainage group can reduce the loss of digestive juice effectively after their gastrointestinal function recovered, and which is helpful for patients postoperative rehabilitation. Jejunum cavity drainage in pancreasticoduodenectomy is a safe technique.