术前预置胰管支架对胰体尾切除术后胰瘘的预防效果

Clinical observation of preoperative pancreatic stent placement in the prevention of pancreatic fistula after distal pancreatectomy

【目的】探讨术前预置胰管支架降低胰体尾切除术后胰瘘发生的几率。【方法】对2016年6月至2018年6月在长海医院拟行开腹胰体尾切除术77例患者随机分成实验组(n=37)与对照组(n=40),两组均接受开腹胰体尾切除手术,对照组手术前未预置胰管支架,实验组手术前预置胰管支架;通过测定各组术后每日腹腔引流量及引流液淀粉酶水平至术后第10天判断胰瘘情况。【结果】实验组和对照组在年龄、性别、手术方式、手术时间、术中出血量、良恶性疾病、术前辅助检查、术后住院时间、术后禁食时间、总费用等临床特征指标差异均无统计学意义(P>0.05)。实验组总体胰瘘情况、B级和C级瘘的总体情况优于对照组(总胰瘘P=0.049,B+C级瘘P=0.033),但其中生化瘘情况与对照组无统计学意义(P>0.05),其余并发症以及二次手术例数两组间无统计学意义(P>0.05)。【结论】术前预置胰管支架可有效减少胰体尾切除术后严重胰瘘的发生,且安全可行。

【Objective】To explore the possibility of preoperative pancreatic stent placement to reduce the incidence of pancreatic fistula after distal pancreatectomy.【Methods】A total of 77 patients with the schedule for open distal pancreatectomy from June 2016 to June2018 in Changhai Hospital were randomly divided into experimental group(n=37)and control group(n=40).Both groups underwent open pancreatectomy.There was no preoperative pancreatic duct stent in the control group,while preoperative pancreatic duct stent was placed in the experimental group.The pancreatic fistula was assessed by measuring the daily abdominal drainage volume and amylase level of drainage fluid in both groups up to the 10 th day after operation.【Results】There were no significant differences in age,sex,operation mode,operation time,intraoperative bleeding volume,benign and malignant diseases,preoperative auxiliary examination,postoperative hospitalization time,postoperative fasting time and total cost between the experimental group and the control group(P>0.05).The overall situation of pancreatic fistula,grade B and C fistula were better than those in the control group(total pancreatic fistula P=0.049,grade B+C fistula P=0.033),but there was no significant difference in biochemical fistula,other complications and secondary operation between the two groups.【Conclusion】Preoperative placement of pancreatic duct stent can effectively reduce the occurrence of severe pancreatic fistula after pancreatic body and tail resection,which is safe and feasible.