改良Blumgart吻合与传统Blumgart吻合在胰十二指肠切除术中的应用比较

A comparison between modified Blumgart anastomosis and conventional Blumgart anastomosis in pancreaticoduodenectomy

目的探讨改良Blumgart吻合与传统Blumgart吻合对胰十二指肠切除术手术时间、术后胰瘘及住院时间的影响。方法回顾性分析2011年1月1日至2015年1月1日在天津医科大学肿瘤医院行胰十二指肠切除术并采用Blumgart胰肠吻合的104例患者的临床资料，根据术中胰肠吻合方式分为改良组（42例）和传统组（62例）。结果改良Blumgart组平均手术时间为（281±67）min，传统Blumgart组平均手术时间为（300±80）min，两组比较差异无统计学意义（t=-3．928，P〉0．05）。改良Blumgart组术后B＋C级胰瘘发生率为16．7％，传统Blumgart组术后B＋C级胰瘘发生率为16．1％，两组差异无统计学意义（z。=0．106，P〉0．05）。改良Blumgart组术后平均住院时间为24d，传统Blumgart组术后平均住院时间为23d，差异无统计学意义（t=1．263，P〉0．05）。结论以胰管支撑管与胰管结扎固定法代替传统胰管空肠吻合的改良Blumgart法是一种简便、安全可靠的手术方法。具有一定的临床应用价值。

Objective To evaluate modified Blumgart anastomosis and conventional Blumgart anastomosis in operation time, postoperative pancreatic fistula （POPF） and hospital stay in patients undergoing pancreaticoduodenectomy （PD）. Methods The clinical date of 104 PD patients with Blumgart anastomosis in Tianjin Medical University Cancer Hospital from January 1, 2011 to January 1, 2015 were retrospectively divided into the modified group （42 cases） and the conventional group （62 cases） according to ways pancreaticojejunostomy was conducted. Results The average operation time of the modified group was 281±67 minutes, while for the traditional group was 300 ±80 minutes （t = -3. 928, P 〉0. 05 ）. The incidence of postoperative grade B ＋ C pancreatic fistula in the modified Blumgart group was 16. 7% and that was 16. 1% in the conventional group （X2 = 0. 106, P 〉 0.05 ）. The mean postoperative hospital stay of modified group was 24 days, that for the traditional group was 23 days （ t = 1. 263, P 〈 0.05 ） . Conclusions Modified Blumgart anastomosis using pancreatic duct stenting and fixation in place of traditional Blumgart pancreatic duct jejunum anastomosis is feasible, safe and effective during pancreaticoduodenectomy.