植入式胰管空肠吻合术在全腹腔镜胰十二指肠切除术中的应用研究

Application of Imbedding Pancreaticojejunostomy in Pure Laparoscopic Pancreaticoduodenectomy

目的探讨植入式胰管空肠吻合术在腹腔镜胰十二指肠切除术(LPD)中的应用。方法回顾性分析2014年5月至2015年12月期间笔者所在医院85例行LPD患者的临床资料,按照其纳入标准和排除标准,筛选出78例患者行进一步分析研究。根据胰肠吻合方式的不同分为2组,其中42例行传统的胰管对空肠黏膜吻合术(对照组),另外36例行改良的胰肠吻合术即植入式胰管空肠吻合术(改良组)。比较2组患者术后在胰瘘、腹腔感染/脓肿、胆漏、胃排空延迟、出血、肺部感染和切口感染的发生率以及平均住院时间和手术时间等指标上的差异性。结果 2组患者一般资料差异无统计学意义(P>0.05);改良组与对照组相比,术后胰瘘发生率尤其是需特殊处理的B^C级胰瘘发生率明显下降(改良组的8.3%比对照组的31.0%,P<0.05);胰肠吻合时间明显缩短〔改良组的(35.6±12.4)min比对照组的(52.8±24.6)min,P<0.05〕,总手术时间也明显缩短〔改良组的(322.4±23.6)min比对照组的(384.2±30.2)min,P<0.05〕;术后腹腔感染/脓肿、胆漏、胃排空延迟、出血、肺部感染和切口感染的发生率2组间的差异均无统计学意义(P>0.05)。结论植入式胰管空肠吻合术能明显减少LPD术后胰瘘发生率,并缩短胰肠吻合时间和总手术时间。

Objective To investigate the application of imbedding pancreaticojejunostomy in pure laparoscopic pancreaticoduodenectomy. Methods Eighty-five cases of laparoscopic pancreaticoduodenectomy in our hospital from May 2014 to December 2015 were analyzed retrospectively. According with inclusion criteria and exclusion criteria, 78 cases were investigated. They were divided into pancreatic duct-to-jejunum mucosa pancreaticojejunostomy group as controlled group（n=42） and imbedding pancreaticojejunostomy（technique of duct-to-mucosa PJ with transpancreatic interlocking mattress sutures） group as modified group（n=36）. The rates of pancreatic fistula, abdominal infection/abscess, bile leakage, delayed gastric emptying, gastrointestinal/intraabdominal hemorrhage, pulmonary infection, and incision infection were investigated as well as hospital stays and pancreaticojejunostomy time in two groups were compared. Results The rate of pancreatic fistula especially B to C grade pancreatic fistula in the modified group was obviously lower compared with which in the controlled group（8.3% vs. 31.0%, P〈0.05）, pancreaticojejunostomy time of modified group was significantly shortened 〔（35.6±12.4） min vs.（52.8±24.6） min, P〈0.05〕 and total operative time also shortened 〔（322.4±23.6） min vs.（384.2±30.2） min, P〈0.05）. There were no significant difference of the rates of abdominal infection/abscess, bile leakage, delayed gastric emptying, gastrointestinal/intraabdominal hemorrhage, pulmonary infection, incision infection, and hospital stays（P〉0.05）. Conclusions The type of pancreaticojejunostomy has a significant impact on the rate of pancreatic fistula after laparoscopic pancreaticoduodenectomy. Imbedding pancreaticojejunostomy can decrease the rate of pancreatic fistula after operation, and shorten the pancreaticojejunostomy time and total operative time.