一种极简主义改良胰肠内陷式（Jiang式）吻合法的临床研究

Modified invaginated pencreaticojejunostomy approach in pancreaticoduodenectomy： Jiang＇s anastomosis

目的胰十二指肠切除术始终伴随着胰瘘的风险。为减少胰瘘发生，本文对上海东方肝胆外科医院胆道外科团队针对术后胰瘘研发的改良胰肠内陷式吻合法（Jiang式吻合法）的临床可行性和安全性进行了探讨。方法回顾性分析289例施行改良胰肠内陷式吻合法的胰十二指肠切除手术患者临床资料。采用Wileoxon秩和检验、x2检验、单因素logistic回归等方法对术后并发症及其与术后胰瘘的相关性进行分析。结果本组289例患者胰十二指肠切除术后并发症总体发生率为56．4％（163／289）。严重并发症发生45例次，占全部并发症的17．6％（45／255）。患者围手术期死亡率为3．1％（9／289）。术后主要并发症依次为腹腔积液和感染（26．6％）、胃排空延迟（17．6％）、消化道瘘（12．4％）、消化道出血（9．7％）；术后胰瘘发生率为9．3％，且均为生化瘘（6．9％）和B级瘘（2．4％）。结论术后胰瘘是胰十二指肠术后腹腔内出血及感染的重要危险因素。改良的Jiang式胰肠内陷式吻合法操作简便、适用范围广，能较为安全、有效地降低胰十二指肠术后胰瘘的发生率。

Objective To discuss the clinical feasibility and safety of modified invaginated penereaticojejunostomy approach （Jiangg anastomosis） which was developed by the team of biliary surgery department from Shanghai Eastern Hepatobiliary Surgery Hospital. Methods Clinical data of 289 patients receiving modified invaginated pencreatieojejunostomy approach in panereaticoduodeneetomy were retrospectively studied. Wileoxon signed-rank test, Chi-square and logistic regression tests were comprehensively used to evaluate the postoperative complications and the association with POPF. Results One hundred and sixtythree of 289 patients （54.6%） experienced postoperative complications after pancreaticoduodenectomy pro- cedure. There were 45 onsets of severe complications, accounted for 17.6% （45/255）. Perioperative mortality was 3.1% （9/289）. The most common complications included celiac effusion and infection （26. 6% ）, delayed gastric emptying （ 17.6% ）, gastroenterological tract fistula （ 12.4% ）, gastroenterological tract hemorrhage （9.7%）. Additionally, the incidence of POPF was 9.3% , which all conformed as biochemical fistula （6.9%） and grade-B fistula （2.4%）. Conclusions As a risk factor, POPF may play crucial role in celiac hemorrhage and infection associated with pancreaticoduodenectomy. Modified invagina- ted pencreaticojejunostomy approach （Jiang^s anastomosis） with easy manipulation, wide indication, safe and effective performance, could be recommended to reduce POPF incidence.