1+2胰肠吻合在腹腔镜胰十二指肠切除术中的应用

1+2 Pancreaticojejunostomy was used in laparoscopic pancreaticoduodenectomy

目的总结1+2胰肠吻合法用于腹腔镜胰十二指肠切除术(laparoscopic pancreaticoduodenectomy,LPD)的经验,探讨其安全性和有效性。方法回顾性分析包头医学院第二附属医院消化微创中心2016年11月至2018年11月收治并实施LPD患者22例,其中观察组12例采用1+2胰肠吻合术、对照组10例采用胰管空肠黏膜对黏膜吻合术,观察两组的胰肠吻合时间、手术时间、术中出血量,术后胰漏发生率、再次手术率、术后并发症发生率。结果22例患者均顺利完成手术。胰肠吻合时间:观察组(32.8±4.2)min、对照组(39.1±7.4)min;手术时间:观察组(295.8±22.6)min、对照组(318.0±24.8)min;术中出血量:观察组(165.0±30.6)ml、对照组(181.0±25.6)ml;术后并发症胰漏:观察组3例(A级胰漏2例、B级胰漏1例、C级胰漏0例),对照组3例(A级胰漏2例、B级胰漏1例、C级胰漏0例);两组胆漏均为1例;两组均无术后出血,均无术后腹腔感染;胃排空障碍:观察组1例、对照组1例;肺部感染:观察组0例、对照组1例;两组均未行二次手术;两组术后30 d内均无死亡。胰肠吻合时间、手术时间两组比较,差异有统计学意义(P<0.05),其余观察指标两组间比较,差异无统计学意义(P>0.05)。结论采用1+2胰肠吻合在LPD中应用安全、疗效确切、操作简便,值得临床应用并加以推广。

Objective To summarize 1+2 pancreaticojejunostomy used in laparoscopic pancreaticoduodenectomy experience,and to explore its safety and effectiveness.Methods A retrospective analysis was performed on 22 patients undergoing laparoscopic pancreaticoduodenectomy from Nov.2016 to Nov.2018 in Digestive Minimally Invasive Center Second Affiliated Hospital of Baotou Medical College.Twelve patients in the observation group were treated with 1+2 pancreaticojejunostomy.The control group ten cases were treated with pancreatic duct jejunum mucosa-to-mucosal anastomosis.The time of pancreaticojejunostomy,operation time,intraoperative blood loss,incidence of postoperative pancreatic leakage,reoperation rate,and postoperative complications were observed in the two groups.Results The operation was successfully completed in 22 patients.Pancreaticojejunostomy time:observation group(32.8±4.2)min,control group(39.1±7.4)min,the operation time:observation group(295.8±22.6)min,and control group(318.0±24.8)min,intraoperative blood loss:observation group(165.0±30.6)ml,control group(181.0±25.6)ml,pancreatic leakage in postoperative complications:3 cases in observation group(2 cases of grade A pancreatic leakage,1 case of grade B pancreatic leakage,0 case of grade C pancreatic leakage,3 cases of control group(2 cases of grade A pancreatic leakage,1 case of grade B pancreatic leakage,0 case of grade C pancreatic leakage);1 case of bile leakage in both groups.There were no postoperative bleeding in the group;no postoperative abdominal infection;1 case in the observation group of gastric emptying and 1 case in the control group;0 cases in the observation group of pulmonary infection and 1 case in the control group;There were no deaths in either group during the next 30 days.The statistical results showed that there was a significant difference between the two groups of pancreaticojejunostomy anastomosis time and operation time(<0.05),There was no statistical difference between the remaining observation indicators between the two groups(>0.05).Conclusions The 1+2 pancreaticojejunostomy is safe,accurate,and easy to use in laparoscopic pancreaticoduodenectomy.It is worthy of clinical application and promotion.