基于"洪氏胰肠吻合一针法"理念的改良胰胃吻合在胰腺手术消化道重建中的应用

Clinical application of modified pancreaticogastrostomy based on the concept of"Hong's one-stitch method"in digestive tract reconstruction in pancreaticoduodenectomy

目的探讨将基于"洪氏胰肠吻合一针法"理念的改良胰胃吻合应用于胰腺手术消化道重建的安全性及疗效。方法回顾性分析2022年5月至2022年10月河北医科大学第二医院肝胆外科收治的44例采用改良胰胃吻合手术的胰腺肿瘤患者的临床资料,其中男性23例,女性21例,中位年龄54岁,年龄范围18~70岁。总结患者的手术时间、术中出血量、术后一般情况及并发症发生情况等。结果 44例患者均顺利完成手术,其中行腹腔镜胰十二指肠切除术患者29例,腹腔镜保留十二指肠的胰头切除术11例,腹腔镜胰腺中段切除术1例,行开腹胰十二指肠切除术3例。腹腔镜手术胰胃吻合时间(15.4±1.0)min,开腹手术胰胃吻合时间(9.1±0.5)min。44例患者中术后发生A级胰瘘2例(4.55%)、胃排空障碍7例(15.91%),无B、C级胰瘘、胆瘘、胃肠吻合口瘘、腹腔感染、术后出血及围手术期死亡发生。结论将改良胰胃吻合用于胰腺手术消化道重建安全可靠,可以有效降低术后胰瘘发生率,改善患者预后。

Objective To study the safety and therapeutic effects of the modified pancreaticogastrostomy based on the concept of"Hong's one-stitch method"in digestive tract reconstruction in pancreatic surgery.Methods The clinical data of 44 patients who underwent modified pancreaticogastresstomy at the Department of Hepatobiliary Surgery,the Second Hospital of Hebei Medical University from May 2022 to October 2022 were analyzed retrospectively.There were 23 males and 21 females,with a median age of 54 years old(range 18 to 70 years old).The operation time,intraoperative blood loss,postoperative condition and complications were analysed.Results All the 44 patients completed the operation successfully.There were 29 patients who underwent laparoscopic pancreaticoduodenectomy,11 patients laparoscopic duodenum-preserving pancreatic head resection,1 patient laparoscopic central pancreatectomy,and 3 patients open pancreaticoduodenectomy.The time required for the pancreaticogastrostomy was(15.4±1.0)min in laparoscopic surgery,and(9.1±0.5)min in open surgery.There were 2 patients who developed grade A pancreatic fistula(4.55%,2/44)and 7 patients gastric emptying disorder(15.91%,7/44).There were no grade B or C pancreatic fistula,biliary fistula,gastrointestinal anastomotic fistula,abdominal infection,postoperative bleeding and perioperative death.Conclusion The modified pancreaticogastrostomy for digestive tract reconstruction in pancreatic surgery was safe and reliable.It effectively reduced the incidence of postoperative pancreatic fistula and improved prognosis of patients.