改良胰管空肠吻合方式在胰十二指肠切除术中的临床应用

Clinical application of modified pancreaticojejunostomy for pan creat-oduodenectomy

目的:探讨改良胰管空肠吻合术在预防胰十二指肠切除术(PD)后严重胰瘘发生的临床应用价值。方法:我院2013年1月—2016年12月对64例PD患者分别采用改良式胰管空肠吻合方式与间断胰管空肠黏膜吻合方式,其中31例行改良式胰管空肠吻合、33例行间断式胰管空肠吻合,比较两组术中及术后相关并发症情况。结果:两组术中失血量、手术时间、术后再出血率、术后胃排空障碍发生率、术后腹腔感染发生率等指标比较差异均无统计学意义(P>0.05)。两组胰瘘总发生率比较差异无统计学意义(P>0.05),但改良胰管空肠吻合组术后B或C级胰瘘显著少于间断式胰管空肠吻合组(P<0.05)。结论:改良胰肠吻合术可减少术后严重胰瘘的发生率。

Objective： To explore the effect of modified pancreaticojejun-ostomy on inci-dence of severe pancreatic fistula after pancreato-duodenecto my.Methods： The clinical data of64 patients undergoing pancreatoduodenectomy with application of duct-to-mucoca pancreaticcojejunostomy were analyzed retrospectively.Interrupted suture technique and modified technique were performed in 31 and 33 patients, respectively.Postoperative complications, data during and after pan-creatoduodenectomy between two groups were compared.Results： There were no significant differences in intraoperative blood loss,operating time,postoperative morbidity of gastrointestinal,intraabdominal hemorrhage,delayed gastric emptying,and intraabdominal abscess（P〈0.05）.Although there was no significant difference in the incidence of postoperative pancreatic fistula（P〈0.05）, the grades B/C postoperative pancreatic fistula in modified parachute suture group was significantly less than in interrupted suture group（P〈0.05）. Conclusions： Modified pancreaticojejunostomy technique in pancreatoduodenectomy can reduce the incidence of severe postoperativepancreatic fistula.