prolene线单层连续吻合在保留幽门的胰十二指肠切除术中的应用

Application of single layer continuous suture with prolene in pylorus preserving pancreaticoduodenectomy

目的 探讨prolene线单层连续吻合在保留幽门的胰十二指肠切除术（PPPD）中的临床应用价值。方法收集2013年11月至2014年11月在该院行的13例患者（PPPD组）的临床资料,均采用4-0、5-0、4-0 prolene线单层连续缝合分别行胰肠吻合、胆肠吻合、肠肠吻合。另收集2013年2~11月行传统非保留幽门胰十二指肠切除术（Whipple）的13例患者（Whipple组）的临床资料,各吻合口均采用4-0薇乔线间断缝合。观察比较两组患者围术期病死率、胃排空障碍发生率,以及各吻合口完成时间和术后吻合口瘘的发生率。结果 两组均顺利完成手术,无围术期死亡患者。PPPD组患者术后胃排空障碍发生率为7.69%（1/13）,Whipple组为23.07%（3/13）;PPPD组患者平均胰肠吻合时间、胆肠吻合时间、肠肠吻合时间分别为（18±4）、（15±3）、（15±4）min,无吻合口瘘发生;Whipple组平均胰肠吻合时间、胆肠吻合时间、胃肠吻合时间分别为（24±3）、（22±3）、（21±3）min,3例（23.07%）出现胰瘘。结论 prolene线单层连续吻合应用于保留幽门的胰十二指肠切除术中具有吻合时间短、吻合口瘘发生率低等优点,适宜临床推广应用。

Objective To investigate the clinical application value of single layer continuous suture with prolene line in pylorus preserving pancreaticoduodenectomy. Methods The clinical data in 13 patients undergoing pylorus preserving pancre aticoduodenectomy （PPPD） in our hospital from November 2013 to November 2014 were collected. The single layer continuous sutures with 4-0,5-0,4-0 prolene suture lines were performed in pancreaticojejunostomy, cholangioenterostomy and enteroen- terostomy. Moreover the clinical data in 13 patients undergoing non-pylorus preserving pancreaticoduodenectomy （Whipple） from February 2013 to November 2013 were collected. The each anastomofic stoma was performed the interrupted suture by adopting 4-0 Vicryle suture lines. The perioperative fatality rate, occurrence rate of gastric emptying dysfunction, anastomosis stoma com- pleting time and occurrence rate of postoperative anastomotic fistula were observed and compared between the two groups. Results The operation in the two groups was successfully completed without perioperative death case. The occurrence rate of postopera- tive gastric emptying dysfunction was 7.69% in the PPPD group and 23.07% in the Whipple group respectively. The average time of pancreatieojejunostomy, cholangioenterostomy and enteroenterostomy in the PPPD group was （18±4）, （15±3）, （15±4）min respec tively, no anastomotic fistula occurred;which in the Whipple group was （24±3）, （22±3）, （21±3 ） min respectively, 3 cases appeared pancreatic leakage. Conclusion The application of single layer continuous suture with prolene line in pylorus preserving pan- creaticoduodenectomy has the advantages of short operating time,low occurrence rate of gastric emptying dysfunction, etc. which is suitable for clinical promotion and application.