不同吻合手术对胰十二指肠切除术后并发症发生率的影响

The effect of different anastomotic surgeries on the incidence of complications after pancreaticoduodenectomy

目的 :探讨不同吻合手术对胰十二指肠切除术(PD)后并发症发生率的影响。方法 :回顾性分析经胰管空肠黏膜-黏膜吻合(A组,n=38)、套入式胰肠端端吻合(B组,n=32)及胰腺空肠捆绑式吻合(C组,n=30)方案行PD治疗的100例患者临床资料。比较其术后相关并发症发生率及胰瘘严重程度差异,记录其术后1年时胰腺外分泌功能指标[粪弹性蛋白酶(FE)]、内分泌功能指标[胰高血糖素(GLC)、生长抑素(SS)]、营养状况指标[体重指数(BMI)、血清白蛋白、前白蛋白]及生活质量[癌症患者生命质量测定量表(FACT-G)]评估结果差异。结果 :三组患者均无围术期死亡病例;术后并发症发生率显示:C组<A组<B组;C组胰瘘发生率及C级率均明显低于其他两组,但A、B组比较无统计学意义。术后1年时,三组患者胰腺外分泌功能指标、胰腺内分泌功能指标及营养状况指标检测结果比较均无统计学意义。C组患者FACT-G评分明显高于其他两组,且A组评分结果高于B组,差异均有统计学意义。结论 :三种吻合手术均在PD治疗中有一定应用价值,其中胰腺空肠捆绑式吻合法能有效降低术后并发症发生风险,对改善患者生活质量有利。

Objective To investigate the effect of different anastomotic surgeries on the incidence of complications after pancreaticoduodenectomy(PD). Methods The clinical data of 100 patients treated with PD by pancreatic duct jejunal mucosa anastomosis(group A, n=38), encasing pancreatic and intestinal anastomosis(group B, n=32) and pancreatic jejunal bundle anastomosis(group C, n=30) were retrospectively analyzed. The incidence of postoperative complications and the severity of pancreatic fistula were compared. The pancreatic exocrine function indexes at 1 year after surgery [fecal elastase(FE) ], endocrine function indexes [glucagon(GLC), somatostatin(SS) ], nutritional status indexes [body mass index(BMI), serum albumin, prealbumin] and the quality of life score [Functional Assessment of Cancer Therapy-General(FACT-G) ] were recorded. Results There was no perioperative death in the three groups. The incidence of postoperative complications showed group C < group A < group B. The incidence of pancreatic fistula and grade C rate were significantly lower in group C than the other two groups, but there was no significant difference between group A and group B.1 year after surgery, there were no significant differences among the three groups in pancreatic exocrine function indexes, pancreatic endocrine function indexes and nutritional status. The FACT-G score showed group C > group A > group B. Conclusion The three anastomotic surgeries are of certain application value in PD, and pancreatic jejunal bundle anastomosis can effectively reduce the risk of postoperative complications, which is good for improving the quality of life of patients.