胰管空肠黏膜吻合联合桥襻引流对Whipple术患者应激性高血糖的影响相关机制研究

Effects of pancreaticojejunostomy mucosal anastomosis combined with bridging loop drainage on stress hyperglycemia in patients with Whipple surgery

目的探讨与研究胰管空肠黏膜吻合联合桥襻引流对Whipple术患者应激性高血糖的影响相关机制。方法前瞻性选择2015年7月至2021年8月在池州市人民医院进行Whipple术的患者60例作为研究对象,根据1∶1简单分配原则把患者分为研究组与对照组,各30例。研究组给予胰管空肠黏膜吻合联合桥襻引流,对照组给予胰肠吻合联合桥襻引流治疗。记录手术时间、胰肠吻合时间、胰管空肠黏膜吻合时间、术中出血量等;记录术后肛门排气、拔除胃管、进食半流质以及住院时间等;比较两组术前1 d与术后7 d的血清前白蛋白、转铁蛋白含量;观察两组患者的应激性高血糖、并发症发生情况。结果研究组的胰管空肠黏膜吻合时间为(37.19±7.08)min,明显少于对照组[(55.33±8.91)min],差异有统计学意义(P<0.05)。研究组的术后肛门排气时间、术后拔除胃管时间、术后进食半流质时间和术后住院时间为(2.13±0.34)、(3.19±0.33)、(6.38±0.74)、(24.87±2.32)d,明显少于对照组[(3.19±0.44)、(4.62±0.26)、(8.87±0.81)、(27.27±3.44)d],差异均有统计学意义(P<0.05)。两组术后7 d的血清前白蛋白、转铁蛋白含量明显高于术前1 d,研究组为(366.39±14.58)g/L、(3.33±0.14)mg/L,明显高于对照组[(361.49±17.82)g/L、(2.78±0.17)mg/L],差异均有统计学意义(P<0.05)。研究组术后7 d的应激性高血糖发生率为3.33%,明显低于对照组(20.00%),差异有统计学意义(P<0.05)。研究组术后7 d的胃排空障碍、切口感染、胰漏、胆漏等并发症发生率为6.67%,明显低于对照组(26.67%),差异有统计学意义(P<0.05)。结论相对于胰肠吻合,胰管空肠黏膜吻合联合桥襻引流在Whipple术患者的应用能减少术中创伤,促进患者康复,还可减少应激性高血糖的发生,改善患者的营养状况,降低并发症的发生。

Objective To investigate and study the related mechanism of the effect of pancreaticojejunal mucosal anastomosis combined with bridge drainage on stress hyperglycemia in patients with Whipple surgery.Methods From July 2015 to August 2021,A total of 60 patients who underwent Whipple surgery in Chizhou People's Hospital were prospectively selected as the research subjects,and the patients were divided into the study group and the control group with 30 cases in each groups accorded to the 1:1 simple allocation principle.The study group were given pancreaticojejunostomy combined with bridging loop drainage,while the control group were given pancreaticojejunostomy combined with bridging loop drainage.The operation time,pancreaticojejunostomy time,pancreaticojejunostomy mucosal anastomosis time,intraoperative blood loss,postoperative anal exhaust,gastric tube removal,semi-liquid feeding and hospitalization time were recorded;the two groups were recorded 1 day before operation and 7 days after operation The levels of serum prealbumin and transferrin on d were compared;the stress hyperglycemia and complications of the two groups were observed.Results The time of pancreaticojejunal mucosal anastomosis in the study group was(37.19±7.08)min,which was significantly shorter than that in the control group[(55.33±8.91)min],and the difference was statistically significant(P<0.05).The postoperative anal exhaust time,postoperative gastric tube removal time,postoperative semi-liquid feeding time and postoperative hospital stay in the study group were(2.13±0.34),(3.19±0.33),(6.38±0.74),(24.87±2.32)d,which were significantly less than those in the control group[(3.19±0.44),(4.62±0.26),(8.87±0.81),(27.27±3.44)d],and the differences were statistically significant(P<0.05).The levels of serum prealbumin and transferrin in the two groups at 7 days after operation were significantly higher than those at 1 day before operation,and those in the study group were(366.39±14.58)g/L,(3.33±0.14)mg/L,which were significantly higher than the control group[(361.49±17.82)g/L,(2.78±0.17)mg/L],and the differences were statistically significant(P<0.05).The incidence rates of stress hyperglycemia at 7 days after operation in the study group were 3.33%,which were significantly lower than that in the control group(20.00%),and the difference was statistically significant(P<0.05).The incidence rates of complications such as gastric emptying disorder,incision infection,pancreatic leakage and bile leakage in the study group was 6.67%at 7 days after operation,which were significantly lower than that in the control group(26.67%),and the difference was statistically significant(P<0.05).Conclusion Compares with pancreaticojejunostomy,the application of pancreaticojejunostomy combined with bridging loop drainage in patients with Whipple surgery can reduce intraoperative trauma,promote patients'recovery,reduce the occurrence of stress hyperglycemia,and improve the nutritional status of patients.It can reduce the incidence of complications.