胰十二指肠切除术中应用单层连续缝合方式行胰肠吻合的效果

Application of pancreaticojejunal single layer continuous suture in pancreatoduodenectomy

目的探讨胰十二指肠切除术(PD)中应用单层连续缝合方式行胰肠吻合的效果。方法回顾性分析2016-09—2020-10郑州大学第一附属医院行PD手术的129例患者的临床资料。根据胰肠吻合方式分为胰肠单层连续缝合组(改良组,75例)与传统端-侧套入式胰肠吻合组(传统组,54例)。比较2组患者的一般资料、手术时间、术中胰肠吻合时间和出血量,以及术后住院时间、并发症(出血、胆漏、胃排空障碍、肺部感染、腹腔感染、胰瘘等)发生率、再次手术率与病死率。结果2组患者的一般资料、术中出血量、手术时间,以及术后住院时间、并发症发生率、再手术率和病死率等指标,差异均无统计学意义(P>0.05)。但改良组的胰肠吻合时间明显低于传统组,差异有统计学意义(P<0.05)。结论PD术中采取单层连续缝合方式行胰肠吻合,具有操作简单,吻合时间短,技术难度相对较低,且不增加术后并发症发生率等优点。但仍需多中心、大样本前瞻性随机对照研究(RCT)予以验证。

Objective To investigate the effect of single layer continuous suture for pancreaticoduodenectomy(PD).Methods The clinical data of 129 patients undergoing PD surgery in the First Affiliated Hospital of Zhengzhou University from September 2016 to October 2020 were retrospectively analyzed.According to the pancreaticojejunostomy method,the patients were divided into the single layer continuous suture pancreaticojejunostomy group(modified group,75 cases)and the traditional end-to-side fitting pancreaticojejunostomy group(traditional group,54 cases).General information,operation time,intraoperative pancreaticoenterostomy time,blood loss,postoperative hospital stay,incidence of complications(hemorrhage,biliary leakage,gastric empting disorder,pulmonary infection,abdominal infection,pancreatic fistula,etc.),reoperation rate and mortality of 2 groups were compared.Results There were no significant differences in general information,intraoperative blood loss,operation time,postoperative hospital stay,incidence of complications,reoperation rate and mortality between 2 groups(P>0.05).However,the pancreaticoenteroanastomosis time in the modified group was significantly lower than that of the traditional group,and the difference was statistically significant(P<0.05).Conclusion Single layer continuous suture for pancreaticoenterostomy during PD has the advantages of simple operation,short anastomosis time,relatively low technical difficulty,and does not increase the incidence of postoperative complications.However,multi-center,large sample prospective randomized controlled study(RCT)is still needed to confirm.