单层胰空肠吻合胰管外引流在胰腺质地柔软病例应用价值研究(附64例报告)

Application of single layer pancreaticojejunostomy with external drainage of the pancreatic duct in patients with soft pancreas during pancreaticoduodenectomy:A report of 64 cases

目的探讨单层胰空肠吻合胰管外引流在胰腺质地柔软病人胰十二指肠切除术（PD）中的应用价值。方法回顾性分析2011年2月至2012年11月复旦大学附属华山医院胰腺外科行PD的64例胰腺质地柔软病人的临床资料,均采用单层胰空肠吻合胰管外引流,观察术中情况及术后临床疗效。结果 64例病人手术时间6.2（4.0-9.5）h,术中出血量400（50-2900）m L,胰空肠吻合时间15.6（11-25）min,术后住院时间14.2（8-43）d。35例（54.7%）发生术后并发症,其中胰瘘30例（46.9%）,分别为A级23例和B级7例;胃排空延迟3例（4.7%）;腹腔内脓肿4例（6.3%）;腹腔内出血1例（1.6%）;切口感染3例（4.7%）。所有并发症均经相应治疗后治愈,无再次手术或围手术期死亡发生。Clavien-Dindo术后并发症分级：Ⅰ级3例（4.7%）,Ⅱ级27例（42.2%）,Ⅲa级5例（7.8%）。结论单层胰空肠吻合胰管外引流可减少PD术后有临床意义的胰瘘（B、C级）发生,尤其适用于胰腺质地柔软病人,值得临床推广。

Objective To investigate the application value of single layer pancreaticojejunostomy with external drainage of the pancreatic duct in patients with soft Pancreas during panereaticoduodenectomy. Methods The clinical data of 64 patients with soft pancreas who received single layer pancreaticojejunostomy with external drainage of the pancreat- ic duct during pancreaticoduodenectomy between February 2011 and November 2012 in Department of Pancreatic Surgery, Huashan Hospital, Shanghai Medical College of Fudan University were analyzed retrospectively. Intraoperative condition and postoperative therapeutic effect were observed. Results The operation time of the 64 patients was 6.2 （4.0-9.5） h, with intraoperative blood loss of 400 （50-2900） mL, anastomosis time of 15.6 （ 11-25 ） rain, and postopera- tive hospital stay of 14.2 （8-43） d. A total of 35 cases （54.7%） had postoperative complications, including 30 cases of pancreatic fistula （46.9%）composed of 23 cases of grade A and 7 cases of grade B. There were 3 cases （4.7%）of delayed gastric emptying, 4 bases （6.3%）of intra-abdominal abscess, 1 ease （1.6%）of intra-abdominal hemorrhage and 3 cases （4.7%） of incision infection. All the complications were cured after corresponding treatment and none had reoperation or perioperative death. The Clavien-Dindo classification of surgical complications： level I in 3 cases（4.7%） ,level II in 27 cases （42.2%）, and level m a in 5 cases （7.8%）. Conclusion Single layer pancreaticojejunostomy with external drainage of the pancreatic duct during pancreati-coduodenectomy can obviously reduce clinically significant pancreatic fistula （B/C grade） , is especially appropriate for those with soft pancreas. It is worthy of further clinical promotion.