改良Blumgart胰肠吻合在胰十二指肠切除术中的应用

Application of modified Blumgart pancreaticojejunostomy in pancreaticoduodenectomy

背景与目的:胰肠吻合技术与方式是胰十二指肠切除术(PD)后胰瘘发生的重要影响因素,然而目前尚未确定哪种胰肠吻合方式在降低术后PD的发生率上具有绝对优势,本研究探讨笔者团队设计的改良Blumgart胰肠吻合在PD术中的应用效果与安全性。方法:将2014年8月-2017年1月55例PD术中采用传统空肠套入式胰肠吻合的患者(传统组)与2017年2月-2019年8月53例PD术中采用改良Blumgart胰肠吻合的患者(改良组)行回顾性历史对照研究,比较两组患者的相关临床相关指标及术后并发症发生率。结果:两组患者术前临床资料、总手术时间、胰肠吻合时间、术中失血量、术后病理以及胆瘘、胃排空延迟发生率均无统计学差异(均P>0.05);而在胰瘘、腹腔出血、腹腔感染的术后并发症发生率上,改良组均较传统组明显降低(均P<0.05),其中改良组生化漏4例(7.5%),B/C级胰瘘3例(5.7%);传统组生化漏12例(21.8%)、B/C级胰10例(18.2%);改良组术后无发生腹腔出血和腹腔感染的病例,且无死亡病例,而传统组腹腔出血8例,腹腔感染7例,死亡4例。结论:PD术中采用改良Blumgart胰肠吻合可有效降低术后胰瘘、腹腔出血、腹腔感染并发症的发生率,在临床上有一定的应用价值。但这一结论仍需通过多中心、前瞻性的临床研究作进一步评价。

Background and Aims:The technique and method of pancreaticojejunostomy are important influential factors for the occurrence of pancreatic fistula after pancreaticoduodenectomy(PD).However,none of the pancreaticojejunostomy procedures has a superiority over others in reducing the incidence of postoperative pancreatic fistula so far.This study was conducted to investigate the efficacy and safety using the modified Blumgart pancreaticojejunostomy developed by the authors’team in PD.Methods:A retrospective historical control study was performed,which included 55 patients undergoing the conventional invagination pancreaticojejunostomy after PD during August 2014 to January 2017(conventional group)and 53 patients undergoing the modified Blumgart pancreaticojejunostomy after PD from February 2017 to August 2019(modified group).The main clinical variables and the incidence rates of postoperative complications were compared between the two groups of patients.Results:There were no significant differences in preoperative clinical data,total operative time,operative time for pancreaticojejunostomy and intraoperative blood loss as well as the incidence rates of bile leakage and delayed gastric emptying between the two groups(all P>0.05).The incidence rates of postoperative complications that included pancreatic fistula,abdominal hemorrhage and abdominal infection in modified group were significantly lower than those in conventional group(all P<0.05).Biochemical leakage occurred in 4 cases(7.5%)and B/C pancreatic fistula occurred in 3 cases(5.7%)in modified group,while biochemical leakage occurred in 12 cases(21.8%)and B/C pancreatic fistula occurred in 10 cases(18.2%)in conventional group;no abdominal hemorrhage and infection as well as death occurred in modified group,while there were 8 cases of abdominal hemorrhage,7 cases of abdominal infection and 4 cases of death in traditional group.Conclusion:Using the modified Blumgart pancreaticojejunostomy can effectively reduce the incidence rates of pancreatic fistula,abdominal bleeding and abdominal infection,so it has certain clinical application value.However,this conclusion still needs to be verified by multi-center prospective clinical studies.