Blumgart吻合在胰十二指肠切除术后胰瘘防治中的作用

Effect of Blumgart anastomosis in prevention and treatment of pancreatic fistula after pancreaticoduodenectomy

目的评价Blumgart吻合方法对胰十二指肠切除术后胰瘘及其他并发症发生的影响。方法回顾南京医科大学附属南京医院2005年1月-2011年12月实施胰十二指肠切除术的190例患者的临床资料。将患者按照不同的吻合方式为3组:Blumgart吻合组(A组)55例,胰管空肠黏膜端侧吻合组(B组)65例,套入式吻合组(C组)70例。比较不同吻合方法术后胰瘘及其他并发症的发生率。各组并发症发生率的比较采用行×列χ2检验。结果全部患者均无围手术期死亡,术后并发症发生率为48.4%(92/190),其中A组为25.5%(14/55),B组为52.3%(34/65),C组为62.9%(44/70),3组比较差异有统计学意义(χ2=17.850,P<0.05)。术后胰瘘发生率20.5%(39/190),其中A组为5.5%(3/55),B组为20%(13/65),C组为32.9%(23/70)。在胰管内径<3 mm的患者中,不同吻合方式的患者胰瘘发生率差异有统计学意义(χ2=6.089,P<0.05),在≥3mm的患者时,不同吻合方式患者胰瘘的发生率差异无统计学意义(χ2=5.436,P>0.05)。结论 Blumgart胰肠吻合方法安全、简单、省时,明显降低胰瘘的发生率,值得推广。

Objective To investigate the effect of Blumgart anastomosis （BA） on pancreatic fistula （PF） and other complications after pan- creaticoduodenectomy. Methods The clinical data of 190 patients who underwent pancreaticoduodenectomy in our hospital from January 2005 to December 2011 were analyzed retrospectively. The patients were divided into three groups, with 55 patients in the BA group, 65 pa- tients in the duct -to -mucosa anastomosis group, and 70 patients in the invaginated pancreaticojejunostomy group. The incidence rates of PF and other complications after different methods of anastomosis were compared. The chi - square test was applied for comparison of the in- cidence of complications between groups. Results No deaths occurred during surgery. The incidence rate of postoperative complications was 48.4% （92/190）, and that of PF was 20.5% （39/190）, with 5.5% （3/55） in the BA group, 20% （13/65） in the duct -to -mucosa anastomosis group, and 32.9% （23/70） in the invaginated pancreaticojejunostomy group. In the pancreatic duct with a diameter of 〈 3 ram, the incidence rate of PF showed a significant difference between the three groups （X2 = 6. 089, P 〈 0.05 ）, while in the pancreatic duct with a diameter of ≥ 3 mm, there was no significant difference in PF between the three groups （X2 = 5. 436, P 〈 0.05 ）. Conclusion BA is a safe, simple, and time -saving technique and can reduce the incidence of PF, which is worthy of clinical application.