单层与双层胰管空肠吻合在胰十二指肠切除术中的应用效果比较

Comparison of application effects of single-layer and double-layer pancreaticojejunostomy in pancreaticoduodenectomy

目的:比较单层与双层胰管空肠吻合在胰十二指肠切除术(PD)中的应用效果。方法:选取2019年2月至2021年2月于该院行PD的90例患者进行前瞻性研究,按随机数字表法分为观察组和对照组各45例。术中,观察组采用单层胰管空肠黏膜吻合,对照组采用双层胰管空肠吻合,比较两组术中出血量、术后首次进食时间、术后住院时间、手术时间、并发症发生率、匹兹堡睡眠质量指数(PSQI)评分以及术后胰瘘患者的性别、胰管直径、胰腺质地。结果:观察组术中出血量低于对照组,术后首次进食时间和住院时间短于对照组,差异有统计学意义(P<0.05);两组手术时间比较,差异无统计学意义(P>0.05);观察组胰瘘发生率为4.44%,明显低于对照组的26.67%,差异有统计学意义(P<0.05);两组消化道出血、胃排空障碍、胆瘘、腹腔感染、肺感染、切口感染等并发症发生率比较,差异无统计学意义(P>0.05);术后1个月,两组PSQI评分均低于术前,且观察组低于对照组,差异有统计学意义(P<0.05);两组术后胰瘘患者的性别、胰管直径、胰腺质地比较,差异无统计学意义(P>0.05)。结论:单层胰管空肠吻合用于PD优于双层胰管空肠吻合,可降低术后胰瘘发生率、PSQI评分和术中出血量,缩短患者术后首次进食时间和住院时间。

Objective:To compare application effects of single-layer and double-layer pancreaticojejunostomy in pancreaticoduodenectomy(PD).Methods:A prospective study was conducted on 90 patients who underwent PD in the hospital from February 2019 to February 2021.They were divided into observation group and control group according to the random number table method,45 cases in each.During the surgery,the observation group was treated with single-layer pancreaticojejunostomy,while the control group was treated with double-layer pancreaticojejunostomy.The intraoperative blood loss,the postoperative first feeding time,the postoperative hospitalization time,the operation time,the incidence of complications,the Pittsburgh sleep quality index(PSQI)score,and the gender,the pancreatic duct diameter and the pancreatic texture of the patients with postoperative pancreatic fistula were compared between the two groups.Results:The intraoperative blood loss in the observation group was lower than that in the control group,the first feeding time and the postoperative hospitalization time were shorter than those in the control group,and the differences were statistically significant(P<0.05).The incidence of pancreatic fistula in the observation group was 4.44%,which was significantly lower than 26.67%in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of complications such as gastrointestinal bleeding,gastric emptying disorder,biliary fistula,abdominal infection,pulmonary infection and incision infection between the two groups(P>0.05).1 month after the surgery,the PSQI scores of the two groups were lower than those before the surgery,that of the observation group was lower than the control group,and the differences were statistically significant(P<0.05).There were no significant differences in gender,pancreatic duct diameter and pancreatic texture between the two groups(P>0.05).Conclusions:Single-layer pancreaticojejunostomy for PD is superior to double-layer pancreaticojejunostomy.It can reduce the incidence of postoperative pancreatic fistula,the PSQI score and the intraoperative blood loss,and shorten the first feeding time and the hospitalization time.