胰十二指肠切除术后早期胰管支撑管内引流及外引流的疗效比较

A prospective randomized controlled trial of pancreatic duct stent internal versus external drainage with pancreaticojejunostomy for the early curative effect after pancreaticoduodenectomy

目的 比较胰十二指肠切除术（PD）后早期胰管支撑管内、外引流的临床疗效.方法 采用前瞻性研究方法,将2010年1月至2013年3月收治的219例接受PD的患者根据胰液引流方式随机分为外引流组110例和内引流组109例.内引流组术中将胰管支撑管留置于空肠内,外引流组胰管支撑管通过肠壁和腹壁留置于体外.比较两组患者术中出血、手术时间、术后住院时间、病死率及胰漏等相关并发症发生情况.结果 与内引流组相比,外引流组的PD术后胰漏（13.6％比22.6％）、胃排空延迟（10.0％比27.5％）、腹腔感染（6.4％比19.3％）、肠梗阻（8.2％比20.2％）及总体并发症（24.5％比41.3％）发生率较低（χ^2=5.735 8～11.047 7,P＜0.05）,胰漏愈合时间较短[（11.5 ±2.93）d比（20.1 ±5.7）d,=5.07,P＜0.01].两组患者术中出血、手术时间、术后住院时间、病死率等指标差异无统计学意义（P＞0.05）.结论 胰管支撑管外引流可有效降低PD术后患者胰漏及总体并发症的发生率,安全可行,值得临床推广应用.

Objective To investigate the drainage with pancreaticojejunostomy on the early effect of pancreatic duct stent internal versus external curative effect after pancreaticoduodenectomy （PD）. Methods The study was a prospective controlled trial. A total of 219 patients undergoing PD from January 2010 to March 2013 were randomly divided into external drainage group （n = 110） and internal drainage group （n = 109）. The pancreatic duct stent was put in the jejunum during the operation in the internal drainage group, while that in the external drainage group was placed outside the body through the jejunum and abdominal wall. The intra-operative blood loss, operative duration, post-operative hospital stay, mortality rate, and the morbidity of pancreratic fistula as well as other complications were compared between the two groups. Results Compared with internal drainage group, pancreatic duct stent external drainage obviously reduced the morbidity of pancreatic fistula （13.6% vs. 22. 6% ）, delayed gastric emptying （ 10. 0% vs. 27.5% ） , abdominal infection （ 6.4% vs. 19. 3% ） , intestinal obstruction （ 8.2% vs. 20. 2% ） along with the overall complications （24. 5% vs. 41.3% ） after PD （χ^2 = 5. 735 8 to 11. 047 7, P 〈 0. 05 ）, and shortened the healing duration of pancreatic fistula （ （ 11.5± 2. 9 ） d vs. （20. 1 ± 5.7 ） d, t = 5.07, P 〈 0.01 ）, while there was no significant difference in the intra-operative blood loss, operative duration, post-operative hospital stay and mortality rate, etc between the two groups （P 〉 0. 05 ）. Conclusions Pancreatic duct stem external drainage can effectively reduce the morbidity of pancreatic fistula and the overall complications after PD, which is safe and feasible. The method is worthy ofpopularization and application clinically.