改良胰肠吻合法联合大网膜铺垫技术在胰十二指肠切除术中的应用

Application of improved pancreaticojejunostomy with greater omental flap in pancreaticoduodenectomy

目的探讨改良胰肠吻合法联合大网膜铺垫技术在胰十二指肠切除术(PD)中的临床疗效。方法回顾性分析2017年1月至2023年1月行胰十二指肠切除术的临床资料,分为2组,改良组(n=33)行改良胰肠吻合法联合大网膜铺垫技术,其中21例为腹腔镜PD;传统组(n=32)开腹PD行传统的胰管-空肠黏膜的胰肠端侧吻合法,对比分析两组围术期指标及术后并发症发生情况。结果改良组胰肠吻合时间、术后住院时间、引流时间小于传统组(P<0.05);改良组发生B级胰瘘共2例(6.10%),显著低于传统组9例(28.13%),差异有统计学意义(P<0.05),但两组手术时间、术中出血量、生化漏、胃排空延迟、胆漏、腹腔感染、腹腔出血等并发症发生率差异无统计学意义(P>0.05)。结论改良胰肠吻合法联合大网膜铺垫技术相比传统吻合方法,可有效降低吻合难度,且安全有效。

objective To explore the clinical efficacy of the improved pancreaticojejunostomy procedure combined with omental coverage in pancreaticoduodenectomy.Methods Clinical data of patients who underwent pancreaticoduodenectomy from Jan.2017 to Jan.2023 were retrospectively analyzed and divided into improved group and traditional group.The improved group(n=33)received the improved pancreaticojejunostomy with omental coverage,21 cases received LPD.The traditional group(n=32)received OPD with the conventional pancreatic duct-mucosa anastomosis.Perioperative indicators and postoperative complications were compared between the two groups.Results In the improved group,pancreaticojejunostomy time,postoperative hospital stay,and drainage were shorter than those in the traditional group(P<0.05).The occurrence rate of grade B and C pancreatic fistula was significantly lower in the improved group than that in the traditional group(6.10%vs 28.13%,P<0.05).There were 2 pancreatic fistula in the improved group,while the traditional group had 9 pancreatic fistula.There were no statistically significant differences in the complication occurrence rates of surgical duration,intraoperative blood loss,biochemical leakage,delayed gastric emptying,bile leakage,abdominal infection and abdominal bleeding between the two groups(P>0.05).Conclusion Compared to traditional anastomosis method,the improved pancreaticojejunostomy combined with omental coverage technique can effectively reduce the difficulty of anastomosis and is safe and effective.