"洪氏一针法"胰管空肠吻合方式在腹腔镜胰十二指肠切除术中的运用

Application of Hong′s single-stitch duct to mucosa pancreaticoenterostomy in laparoscopic pancreaticoduodenectomy

目的探讨"洪氏一针法"胰管空肠吻合方式在腹腔镜胰十二指肠切除术(LPD)中的运用价值。方法回顾性分析2015年4月至2019年3月间吉林大学第一医院肝胆胰外二科收治的300例行LPD患者的临床资料,根据术后有无发生胰瘘分为胰瘘组(43例)和非胰瘘组(257例),其中210例患者使用"洪氏一针法"胰管空肠吻合术,90例使用传统胰管空肠吻合术完成胰肠吻合。采用单因素及多因素logistic回归分析LPD后胰瘘发生的危险因素,比较"洪氏一针法"与传统方式胰肠吻合术在胰肠吻合时间及术后胰瘘发生率方面的差异。结果单因素分析结果显示,体重指数(BMI)、腹部手术史、胰腺质地,胰管直径在胰瘘组和非胰瘘组之间的差异有统计学意义(P值均<0.05)。多因素logistic回归分析结果显示,BMI(OR=1.180,95%CI1.047~1.338,P=0.008)、胰腺质地(OR=0.375,95%CI0.135~0.861,P=0.036)是LPD后胰瘘发生的独立危险因素。与传统胰肠吻合术相比,"洪氏一针法"胰管空肠吻合时间短,术后胰瘘发生率低,但差异均无统计学意义。结论BMI高、胰腺质地软是LPD后胰瘘发生的独立危险因素。与传统胰肠吻合方式相比,"洪氏一针法"胰管空肠吻合并未延长LPD时间和增加术后胰瘘的发生率。

Objective To explore the value of Hong′s single-stitch duct to mucosa pancreaticoenterostomy(HSDMP)in laparoscopic pancreaticoduodenectomy(LPD).Methods The perioperative clinical data of 300 patients undergoing LPD admitted to the Second Department of Hepatobiliary Surgery in the First Hospital of Jilin University from April 2015 to March 2019 were retrospectively analyzed.The patients were categorized into pancreatic fistula group(n=43)and non pancreatic fistula group(n=257).according to the presence or absence of postoperative pancreatic fistula.Among them,pancreaticojejunostomy was performed with HSDMP in 210 patients,and 90 patients underwent traditional pancreaticoenterostomy.Univariate and multivariate logistic regression were used to analyze the risk factors for the development of pancreatic fistula after LPD,and the difference on the time of pancreaticojejunostomy and the incidence of postoperative pancreatic fistula were compared between HSDMP and traditional pancreaticojejunostomy.Results Univariate analysis showed that the differences on BMI,abdominal operation history,pancreatic texture,and pancreatic duct diameter were statistically significant compared with non-pancreatic fistula group(all P value<0.05).Multivariate logistic regression showed that BMI(OR1.180,95%CI1.047-1.338,P=0.008)and pancreatic texture(OR=0.375,95%CI 0.135-0.861,P=0.036)were independent risk factors for pancreatic fistula after LPD.Compared with traditional pancreaticojejunostomy,HSDMP was associated with shorter anastomosis time and low incidence of postoperative pancreatic fistula,but there was no statistical significance between the two groups.Conclusions The independent risk factors for pancreatic fistula are high BMI and soft pancreatic texture.Compared with traditional pancreaticojejunostomy,HSDMP does not prolong LPD time and increase the incidence of postoperative pancreatic fistula.