"荷包背带裤式"胰肠吻合法预防术后胰瘘的研究

Analysis of string-overalls-suture pancreaticojejunostomy in preventing of postoperative pancreatic fistula

目的探讨"荷包背带裤式"胰肠吻合法对胰十二指肠切除术后胰瘘发生率的影响。方法回顾性分析2011年1月至2018年12月间,于大连大学附属中山医院行胰十二指肠切除术的70例患者的临床资料。根据选择胰肠吻合方式的不同分为观察组(45例)和对照组(25例)。观察组采用"荷包背带裤式"胰肠吻合法,对照组采用"胰管对空肠黏膜"胰肠吻合法。该70例手术均由同一团队完成。比较并分析两组患者手术用时及术后并发症发生率的差异。结果两组患者一般资料及术中观察情况的差异无统计学意义。对照组手术用时(4.28±1.10)h,观察组(3.62±0.76)h,两组间差异有统计学意义(t=2.942,P=0.004)。对照组术后胰瘘7例(28.0%),其中6例B级胰瘘,1例C级胰瘘;观察组术后胰瘘3例(6.7%),均为B级胰瘘。术后腹腔内出血对照组6例(24.0%),观察组7例(15.6%);术后腹腔内感染对照组8例(32.0%),观察组8例(17.8%);术后胃瘫对照组3例(12.0%),观察组4例(8.9%)。两组比较,术后胰瘘发生率差异有统计学意义(χ2=4.358,P=0.037),其余并发症发生率的差异无统计学意义(P>0.05)。结论"荷包背带裤式"胰肠吻合法具有操作简单快捷、适用范围较广、吻合牢靠安全等优点,在缩短手术时间及降低术后胰瘘方面有一定优势。

Objective To investigate the influence of string-overalls-suture pancreaticojejunostomy on the incidence of postoperative pancreatic fistula(POPF)in pancreaticoduodenectomy(PD).Methods Clinical data of 70 cases receiving PD in the Affiliated Zhongshan Hospital of Dalian University from Jan.2011 to Dec.2018 were retrospectively studied.All cases were divided into experimental group and control group according to the different ways of pancreaticojejunostomy.Patients in experimental group received string-overalls-suture pancreaticojejunostomy,and those in control group received pancreatic duct jejunal mucosa pancreaticojejunostomy.The 70 cases were performed by the same team.Operative time and the incidence of postoperative complications between the two groups were compared and analyzed.Results There was no statistical differences between the two groups in general data and intraoperative observations.The total operative time was(4.28±1.10)hours in the control group and(3.62±0.76)hours in the experimental group.It was significantly different between the two groups(t=2.942,P=0.004).There were 7(28.0%)cases of POPF including 6 cases of grade B,and 1 case of grade C in the control group,and 3(6.7%)cases of grade B in the experimental group.6(24.0%)cases had postoperative bleeding in the control group,7(15.6%)cases in the experimental group,8(32.0%)cases with abdominal infection in control group,and 8(17.8%)cases in the experimental group.Delayed gastric emptying occurred in 3(12.0%)cases in the control group,and 4(8.9%)cases in the experimental group.It was significantly different for POPF between the two groups(χ2=4.358,P=0.037).And there were no significant differences for other postoperative complications between the two groups(all P>0.05).Conclusion The string-overalls-suture pancreaticojejunostomy has the advantages of simple and quick manipulation,wide indication,safe and reliable pancreaticojejunostomy,and has certain superiorities in shortening operation times and reducing POPF.