离蒂肝圆韧带包裹肝动脉预防胰十二指肠切除术后腹腔出血的临床疗效

Wrapping the hepatic artery with detached ligamentum teres hepatis on preventing abdominal hemorrhage after pancreaticoduodenectomy

目的探讨胰十二指肠切除术(PD)中使用离蒂肝圆韧带包裹肝动脉预防术后腹腔出血的临床效果。方法选取2020年6月至2022年6月于新疆医科大学第一附属医院行PD术患者186例,根据术中是否使用离蒂肝圆韧带包裹肝动脉分为包裹组(86例)和非包裹组(100例),回顾性收集各组病例围术期及术后并发症等临床资料,并进行统计分析。结果包裹组及非包裹组均顺利完成PD术,两组患者在年龄、性别、BMI、住院时间、手术时长和术中出血等基线资料方面差异无统计学意义(P>0.05);术后并发症胰瘘、胆瘘和腹腔感染发生率两组间差异无统计学意义(P>0.05),但包裹组术后出血发生率明显低于非包裹组(1.16%vs 9.00%,P<0.05)。Logistic回归分析显示,B级或C级胰瘘和胆瘘是PD术后腹腔出血的独立危险因素(P<0.05),术中离蒂肝圆韧带包裹肝动脉是PD术后腹腔出血的独立保护因素(P<0.05)。结论PD术中使用离蒂肝圆韧带包裹肝动脉,可能降低术后腹腔出血发生率,该操作简单,不会增加额外并发症,安全可行。

Objective To explore the efficacy of wrapping the hepatic artery with detached ligamentum teres hepatis during pancreaticoduodenectomy(PD)on preventing postoperative intra-abdominal hemorrhage.Methods A total of 186 patients who received PD in the First Affiliated Hospital of Xinjiang Medical University from June 2020 to June 2022 were divided into wrapping group(n=86)and non-wrapping group(n=100)according to whether the detached ligamentum teres hepatis was used to wrap the hepatic artery during the operation.The clinical data on perioperative and postoperative complications were collected and retrospectively analyzed in two groups.Results PD was successfully performed and completed in both groups,and there was no significant difference in age,gender,BMI,length of hospital stay,operative time and intra-operative blood loss between two groups(P>0.05).The incidences of pancreatic fistula,biliary fistula and abdominal infection were similar in two groups(P>0.05),but the incidence of postoperative bleeding in wrapping group was significantly lower than that in non-wrapping group(1.16%vs 9.00%,P<0.05).Logistic regression analysis showed that the pancreatic and biliary fistulas of grade B/C were the independent risk factors for postoperative abdominal bleeding after PD(P<0.05),and the wrapping of the hepatic artery with the detached hepatic round ligament during operation was an independent protective factor for postoperative abdominal bleeding after PD(P<0.05).Conclusion Wrapping the hepatic artery with detached ligamentum teres hepatis during PD surgery may reduce the incidence of postoperative abdominal bleeding and is simple,safe and feasible to perform without additional complications.