三种胰肠吻合方式胰漏的对比研究

Comparative study between different pancreaticojejunostomy methods in the incidence of pancreatic leakage

目的对比研究三种不同胰肠吻合方式在胰十二指肠切除术中胰漏的发生情况。方法回顾性分析2011年5月至2016年5月我院同一术者93例胰十二指肠切除术患者的临床资料,根据手术采用的胰肠吻合方式,分为端端套入捆绑式(A组,n=42),端侧吻合式51例,其中端侧套入(B1组)为15例,因胰管直径限制未能行胰管对空场粘膜吻合,端侧胰管对空肠粘膜吻合(B2组)36例。结果端端套入捆绑吻合方式的胰漏发生率为4.76%(2例),采用端侧吻合方式的(B1组)胰漏发生为20%(3例),B2组胰漏发生率为0.00%,三组间差异比较有统计学意义。结论胰十二指肠切除术中采用端侧套入式的胰肠吻合方式发生胰漏的可能较高,选择何种胰肠吻合方法应根据患者具体条件而定。

Objective To evaluate the incidence rate of pancreatic leakage relative to three different pancreaticojejunostomy methods. Methods Clinical data of 93 patients who underwent pancreaticoduodenectomy from May 2011 to May 2016 by the same surgeon were retrospectively analyzed. Of the cases, 42 cases were performed pancreatico-jejunal end-to-end anastomosis （Group A）. And 51 cases underwent end-to-side anastomosis, in which, 36 （group B2） underwent end-toside mucosa-to-mucosa anastomosis,while the other 15 （group B1） underwent end-to-side anastomosis because of the limited diameter of pancreatic duct. Results The incidence rate of pancreatic leakage in group A, group B 1 and group B2 were 2.52%, 20% and 0.00% respectively, and there was significant difference between the three groups （P〉0.05）. Conclusion There was significant differences in the incidence of pancreatic leakage between the group A, group B1 and group B2. The incidence rate was high in the end-to-side anastomosis group （group B1）. Appropriate anastomosis method should be selected according to the condition of pancreas in order to reduce the incidence rate of pancreatic leakage.