二针双层法胰肠吻合在腹腔镜胰十二指肠切除术中的应用

Application of two-needle double-layer pancreatoenterostomy in laparoscopic pancreaticoduodenectomy

目的:总结二针双层法胰肠吻合在腹腔镜胰十二指肠切除术(laparoscopic panereaticoduodeneetomy,LPD)的经验,探讨其安全性和有效性。方法:回顾性分析包头医学院第二附属医院消化微创中心2017年10月至2022年10月住院实施LPD患者38例,观察组(A组=20例)采用二针双层法连续胰管空肠黏膜吻合术,对照组(B组=18例)采用间断胰管空肠黏膜吻合术,观察两组胰肠吻合时间、手术时间、术中出血量,术后胰瘘、再次手术及术后其它并发症发生率。结果:38例患者中均顺利完成手术。胰肠吻合时间A组(39.25±6.89)min vs.B组(44.89±7.55)min,P=0.021;手术时间A组(293.15±46.61)min vs.B组(314.44±56.80)min,P=0.211;术中出血量A组(165.75±18.44)ml vs.B组(169.44±14.74)ml,P=0.503;术后并发症中胰瘘,A级胰瘘A组2例、B组7例,P=0.043;B级胰瘘A组3例、B组3例,P=0.616,两组均无C级胰瘘;胆瘘两组均为1例,腹腔感染及肺部感染均为1例,两组均无术后出血;胃排空障碍观察组0例、对照组1例;胰肠前引流管平均拔管时间A组(16.8±6.2)d vs.B组(22.3±9.1)d,P=0.043;胆肠后引流管平均拔管时间A组(8.4±3.1)d vs.B组(9.2±3.8)d,P=0.467;平均住院天数A组(18.1±7.4)d vs.B组(18.7±7.9)d,P=0.787;开放进食时间均为5 d;两组均未行二次手术,术后30 d内两组均无死亡。统计结果显示,观察组胰肠吻合时间、胰瘘(A级)发生率、胰肠前引流管平均拔管时间均明显优于对照组,两组间差异有统计学意义(P<0.05),胰瘘(B/C级)及余观察指标两组间差异无统计学意义(P>0.05)。结论:采用二针双层法胰肠吻合在LPD中是安全有效的,简便易学,值得临床应用、推广。

Objective:Summarize the experience of two-needle double-layer pancreatoenterostomy in laparoscopic pancreaticoduodenectomy(LPD),and explore its safety and effectiveness.Method:Retrospective analysis of 38 hospitalized patients with LPD at the Digestive Minimally Invasive Center,the Second Affiliated Hospital of Baotou Medical College from October 2017 to October 2022.The observation group(group A=20 cases)used two-needle double-layer continuous pancreatic duct jejunal mucosal anastomosis,while the control group(group B=18 cases)used intermittent pancreatic duct jejuna mucosal anastomosis.The time of pancreatoenterostomy,surgical time,intraoperative bleeding,postoperative pancreatic leakage,reoperation,and other postoperative complications were observed in both groups.Results:All 38 patients successfully completed the operation.Pancreato-enterostomy time:[group A(39.25±6.89)min vs.group B(44.89±7.55)min,P=0.021];Operation time:[group A(293.15±46.61)min vs.group B(314.44±56.80)min,P=0.211];Peroperative bleeding:[group A(165.75±18.44)ml vs.group B(169.44±14.74)ml,P=0.503];Grade A pancreatic fistula 2 cases in group A and 7 cases in group B,P=0.043;Grade B pancreatic fistula 3 cases in group A and 3 cases in group B,P=0.616,no grade C pancreatic leakage in both groups;There was 1 case of leakage in both groups,1 case of abdominal infection and lung infection,and no postoperative bleeding in both groups;0 cases in the gastric emptying disorder observation group and 1 case in the control group;Mean extubation time of prepancreatic enteric drainage tube:[group A(16.8±6.2)d vs.group B(22.3±9.1)d,P=0.043];The mean extubation time of posterior bilioenteric drainage tube:[group A(8.4±3.1)d vs.group B(9.2±3.8)d,P=0.467];average length of hospital stay:[group A(18.1±7.4)d vs.group B(18.7±7.9)d,P=0.787];open eating time all was 5 days;no second operation was performed in both groups,and no death occurred in both groups within 30 days after operation.The statistical results:The time of pancreatoenterostomy,the incidence of pancreatic fistula(Grade A)and the mean extubation time of anterior pancreaticoenteric drainage tube in the observation group were significantly lower than those in the control group,and the differences between the two groups were significant(P<0.05).Pancreatic fistula(grade B/C)and other observation indicators were not statistically different between the two groups(P>0.05).Conclusion:Two-needle double-layer pancreatoenterostomy is safe,effective,simple and easy to learn in LPD,and worthy of clinical application and promotion.