贯穿式胰管空肠黏膜吻合对胰十二指肠切除术后预防胰漏发生的价值

Pancreatic duct jejunal mucosal anastomosis in the prevention of pancreatic leakage after pancreatoduodenectomy

目的探讨贯穿式胰管空肠黏膜吻合方法对胰十二指肠切除术(PD)后预防胰漏发生的价值。方法回顾性分析2013年1月至2016年11月间在皖南医学院附属弋矶山医院肝胆二科行PD的64例患者的临床资料和胰肠吻合方法,根据治疗方法分为观察组和对照组。观察组39例应用贯穿式胰管空肠黏膜吻合术,对照组25例接受传统套入式胰肠吻合术。比较两组患者手术胰肠吻合时间、术后住院时间及胰瘘发生率等情况。结果观察组患者胰肠吻合时间、术后住院时间及胰瘘发生率,均显著低于对照组,差异有统计学意义(P<0.05)。两组患者在腹腔出血、腹腔感染、胆漏、排气时间及胃瘫方面比较,差异均无统计学意义(P>0.05)。两组患者术后A、B、C级胰漏发生率比较,差异均无统计学意义(P>0.05)。结论胰十二指肠切除术采用贯穿式胰管空肠黏膜吻合简单可靠、胰瘘发生率低。

Objective To evaluate the value of perforation pancreatic duct jejunal mucosa anastomosis in preventing pancreatic leakage after pancreatoduodenectomy. Methods Retrospectively analyzed the clinical data of 64 patients undergoing pancreatoduodenectomy in our department during January 2013 and November 2016.Among them,39 cases（ observation group） were treated by perforation pancreatic duct jejunal anastomosis and 25cases（ traditional control group） were treated by jejunum-inserting pancreas-intestine anastomosis. Pancreatic anastomosis time,postoperative hospital stay and incidence of pancreatic fistula were observed. Results All the operations of 69 patients were successfully completed,pancreatic anastomosis time,postoperative hospital stay and the incidence of pancreatic fistula in observation group was（ 21.3±2.5） min,（ 17.7±3.5） and 17.9%（ 7/39）respectively,significantly lower than those in the control group（ 25. 5 ± 2. 9） min and（ 22. 2 ± 6. 4） and 44. 0%（ 11/25）,differences were statistically significant（ P〈0. 05）. There was no significant difference between the two groups in abdominal bleeding,abdominal infection,bile leakage,exhaust time and gastroparesis（ P〈0. 05）.There was no significant difference in the incidence of pancreatic leakage（ A,B and C level） between the two groups after the surgery（ P〈0. 05）. Conclusions The method of pancreatic duct jejunal mucosa anastomosis in pancreaticoduodenectomy is simple and reliable,the incidence of pancreatic fistula is lower,and it is worth to be promoted.