肝圆韧带在腹腔镜胰十二指肠切除术胰肠吻合中的应用体会

Application of hepatic circular ligaments in laparoscopic pancreatoduodenectomy with pancreatoenterostomy

目的探讨采用胰肠吻合口肝圆韧带包绕方法预防腹腔镜胰十二指肠切除术后胰瘘的效果。方法回顾性分析弋矶山医院肝胆二科自2016年1月至2018年1月52例行腹腔镜胰十二指肠切除术患者的临床资料,其中17例行贯穿式胰肠吻合联合肝圆韧带包绕(试验组),35例仅行贯穿式胰肠吻合(对照组),比较两组术前、术中、术后相关临床指标。结果两组患者年龄、性别、BMI、术前转氨酶、术前白蛋白、术前总胆红素、胰腺质地、胰管直径,手术时间、术中出血量、术后胆漏、术后出血、术后胃排空延迟差异均无统计学意义(均P>0.05)。而试验组术后BL级胰瘘发生率低于对照组(17.6%vs 45.7%,P=0.049),在术后住院时间[(15.00±2.45)d vs(21.40±7.09)d,P=0.021]和术后胰肠引流管拔除时间[(13.89±5.53)d vs(22.40±11.03)d,P=0.049]上,试验组均短于对照组(均P<0.05)。结论采用胰肠吻合口肝圆韧带包绕方法可以降低腹腔镜胰十二指肠切除术后胰瘘的发生率,具有重要的临床意义。

Objective To explore the effect of wrapping the round ligament of pancreas and intestines to prevent the postoperative pancreatic fistula of laparascopic pancreatoduoenectomy. Methods A retrospective analysis was conducted in 52 cases underwent laparoscopic pancreaticoduodenectomy between Jan. 2016 and Jan. 2018. Among them, 17 cases underwent penetrating pancreaticojejunostomy with liver round ligament wrapping（trial group）, and other 35 cases underwent penetrating pancreaticojejunostomy（control group）. The relevant clinical indicators before and after surgery were compared between two groups. Results The differences of age, gender, preoperative BMI, preoperative transaminase, albumin, preoperative total bilirubin, texture of pancreas, pancreatic duct diameter, operation time, intraoperative bleeding volume, postoperative bile leakage, postoperative bleeding, postoperative delayed gastric emptying between two groups were not statistical significant（P〉0.05）; while the incidence of pancreatic fistula in trial group was lower than that in the control group after surgery（P〈0.05）, the postoperative hospitalization duration and postoperative pancreatic enteric drainage time in the trial group were also shorter than those in the control group（all P〈0.05）. Conclusion Wrapping the round ligament of pancreas and enterostomy can reduce the incidence of postoperative pancreatic fistula, which has important clinical significance.