胰十二指肠切除术中放置与不放置胰管支撑管的比较

Comparison between the placement with and without pancreatic duct stent in the pancreaticoduodenectomy

目的评价不同胰肠吻合方式在胰十二指肠切除术中的临床疗效，探讨不放置胰管支撑管的胰肠吻合的适用性。方法我院自2012年1月-2015年12月收治的87例可行胰十二指肠切除术患者，按随机分配方式分为胰管一空肠黏膜对黏膜端侧吻合＋胰管支撑管外引流组（A组，43例）和胰腺-空肠端侧吻合不放置胰管支撑管组（B组，44例），比较两种不同胰肠吻合方式行胰肠吻合术的时间及术后住院时间、术后并发症的发生率。结果术中未放入胰管支撑管组的胰肠吻合时间（平均15．4min）明显小于术中放入胰管支撑管组（平均21．1min），差异有统计学意义（t=7．137，P〈0．05）。B组患者术后住院时间小于A组（t=2．408，P〈0．05，差异有统计学意义）。两组患者术后胰漏、腹腔出血、腹腔感染、胃潴留，差异无统计学意义（x^2=0．181，0．322，0．603，0．001；P〉0．05）。结论胰十二指肠切除术不放置胰管支撑管可减少手术时间，降低术后住院天数，且术后并发症的发生率无显著差异，是安全可靠的。

Objective To evaluate the clinical effect of different ways of pancreaticojejuuostomy in the treatment of pancreaticoduodenectomy, and to investigate the applicability of the pancreaticojejunostomy without pancreatic duct stent. Method From January 2012 to December 2015, 87 cases of patients with feasible pancreaticoduodenectomy, according to the random allocation method for the group that duct-to-mucosa anastomosis with pancreatic duct stent drainage out of body （ Group A, 43 cases） and group that pancre- as-jejunum end-to-side anastomosis without stent. （Group B, 44 cases）, compare the time of two different ways of pancreaticojejunos- tomy and postoperative hospital stay, incidence of postoperative complications. Results The time of without pancreatic duct stem dur- ing operation was significantly less than that with pancreatic duct stent （ t = 7. 137, P 〈 0. 05）. The postoperative hospitalization time of patients in group B was less than that in group A （t = 2. 408, P 〈 0. 05, the difference was statistically significant）. The incidence of postoperative complications such as pancreatic fistula, abdominal bleeding, abdominal infection, delayed gastric empting, the difference was not statistically significant between the two groups （ x^2 = 0. 181, 0. 322, 0. 603, 0. 001 ,P 〉 0. 05 ）. Conclusion It is safe and reliable that without pancreatic duct stent during pancreaticoduodenectomy, which can reduce the operation time and the length of hospital stay, whereas there was no significant difference in the incidence of postoperative complications.