改良胰肠吻合方式对胰十二指肠切除术后患者胰瘘的影响及影响因素分析

Clinical observation and analysis of modified pancreaticojejunostomy on pancreatic fistula after pancreaticoduodenectomy

目的 观察改良胰肠吻合方式对胰十二指肠切除术(PD)后患者并发症的影响,分析胰瘘的影响因素。方法回顾分析2014年1月至2018年6月行PD的62例患者资料,按照胰肠吻合方式分为两组,改良组27例患者采用水平褥式捆绑吻合法,传统组35例患者采用挂线吻合法。数据采用SPSS15.0统计,并发症发生率采用χ^2检验;术中各项指标采用(x±s)描述,采用独立t检验;单因素分析用χ^2检验或Fisher确切概率法,多因素分析用Logistic回归分析法,P<0.05表示差异具有统计学意义。结果改良组患者手术时间、住院时间比传统组少(P<0.05);改良组患者术后胰瘘发生率(7.41%),明显小于传统组(P<0.05);单因素结果显示:病变部位为十二指肠、胰管直径≤3mm、胰腺质地较软和胰肠吻合采用挂线吻合是PD术后胰瘘的危险因素(P<0.05)。经多因素分析发现,胰管直径(<3mm)、病变部位(十二指肠)是PD术后胰瘘的独立危险因素(P<0.05)。结论改良胰肠吻合方式能有效减少PD术后患者胰瘘发生率,缩短手术时间及住院时间。

Objective To observe the clinical outcome of modified pancreaticojejunostomy after pancreaticoduodenectomy (PD) and to analyze the influencing factors of pancreatic fistula. Methods The clinical data of 62 patients with PD in our hospital from January 2014 to June 2018 were analyzed retrospectively . Twenty-seven patients were divided into the modified group, who were treated with horizontal plate-bound anastomosis, while 35 patients were divided into the traditional group, who were treated with hanging-thread anastomosis. The data were analyzed by using SPSS 15.0 software. The incidence of complications were expressed as n(%), and X2 test were used for analysis. Measurement data during the operation were expressed as mean±standard deviation, and were examined by independent t -test. Univariate analysis was performed by χ^2 test or Fisher exact probability method, and multifactor analysis by using Logistic regression. A P value <0.05 was considered as significant difference. Results The operative time and hospitalization time in the modified group were significantly different from those in the traditional group ( P <0.05). Pancreatic morbidity of 7.41% in modified group was significantly lower than 34.29% in traditional group, with significant difference ( P <0.05). By using univariate analysis, it was found that location of lesion (duodenum), diameter of pancreatic duct (≤ 3 mm), the soft texture of pancreas and the anastomosis of pancreaticojejunostomy were the risk factors of pancreatic fistula after pancreatoduodenectomy ( P <0.05). The diameter of pancreatic duct (<3 mm) and the location of lesion (duodenum) were found to be the risk factors of pancreatic fistula after pancreaticoduodenectomy by Logistic multivariate analysis ( P <0.05). Conclusion The modified pancreaticointestinal anastomosis could effectively reduce the incidence of pancreatic fistula and could shorten the time of operation and hospitalization after PD.