摘要
目的探讨胰管对黏膜双层连续胰肠吻合在全腹腔镜胰十二指肠切除术（TLPD）中的应用价值。方法采用回顾性横断面研究方法。收集2017年1-12月吉林大学第二医院收治的21例采用胰管对黏膜双层连续胰肠吻合完成TLPD患者的临床病理资料。吻合方式均采用结肠后Child法，依次行胰肠吻合、胆肠吻合、胃肠吻合。观察指标：（1）手术及术后恢复情况。（2）术后病理学检查情况。（3）随访和生存情况。采用门诊和电话方式进行随访，了解患者术后生存和肿瘤复发转移情况。随访时问截至2018年2月。正态分布的计量资料以X±S表示．偏态分布的计量资料以M（P25，P75）表示。结果（1）手术及术后恢复情况：2l例患者均采用胰管对黏膜双层连续胰肠吻合顺利完成TLPD，手术时间为（352±25）min，胰肠吻合时间为（46±8）min，术中出血量为（168±34）mL，无术中输血患者，术后腹腔引流管拔除时间为（10．1±4．4）d。21例患者中，12例发生生化瘘，3例发生B级胰瘘（均为Ⅱ型胰管），予抑制胰腺分泌和通畅引流后好转；无胆瘘、乳糜瘘、术后出血、腹腔感染、胃排空延迟等并发症发生。2l例患者术后住院时间为（11．3±2．0）d。（2）术后病理学检查情况：21例患者手术切缘均为阴性；肿瘤病理学类型：胆管下段癌8例，壶腹部癌6例，十二指肠乳头及十二指肠癌4例，胰头癌2例，壶腹部神经内分泌癌1例。（3）随访和生存情况：21例患者均获得术后随访，随访时间为3-12个月，中位随访时间为7个月。随访期间，患者均生存，无肿瘤复发转移。结论采用胰管对黏膜双层连续胰肠吻合行TLPD安全可行，吻合效果确切，具有较好应用价值。
Objective To investigate the application value of pancreaticojejunostomy with double-layer continuous suture in total laparoscopic pancreaticoduodenectomy （TLPD）. Methods The retrospective cross- sectional study was conducted. The clinicopathological data of 21 patients who underwent TLPD with pancreaticojejunostomy using double-layer continuous suture in the Second Hospital of Jilin University between January and December 2017 were collected. The anastomosis used Child method, and pancreaticojejunostomy, choledochojejunostomy and gastroenteric anastomosis in turn were done. Observation indicators ： （ 1 ） surgical and postoperative recovery ; （2） postoperative pathological examination ; （3） follow-up and survival situations. Follow- up using outpatient examination and telephone interview was performed to detect postoperative survival and tumor recurrence or metastasis up to February 2018. Measurement data with normal distribution were represented as x±s. Measurement data with skewed distribution were described as M （P25, P75 ）. Results （1） Surgical and postoperative recovery： 21 patients underwent successful TLPD with pancreaticojejunostomy with double-layer continuous suture. The operation time, time of pancreaticojejunostomy and volume of intraoperative blood loss were respectively （352±25） minutes, （46±8） minutes and （168±34） mL. There was no intraoperative blood transfusion. The time of postoperative abdominal drainage-tube removal was （10. 1±4.4） days. Of 21 patients, 12 were complicated with biochemical fistula, and 3 with grading B of pancreatic fistula （ pancreatic duct in type Ⅱ ） , and they were improved by inhibiting pancreatic secretion and drainage patency. There was no occurrence of biliary fistula, chylous fistula, postoperative bleeding, abdominal infection and delayed gastric emptying. The duration of postoperative hospital stay of 21 patients was （ 11.3±2.0 ） days. （ 2 ） Postoperative pathological examination ： surgical margins of 21 patients were negative. The pathological type ： 8, 6, 4, 2 and 1 patients were diagnosed as distal bile duct cancer, ampulla cancer, duodenal papilla and duodenal cancer, pancreatic head cancer and neuroendocrine cancer of ampulla, respectively. （3） Follow-up and survival situations ： 21 patients were followed up for 3-12 months, with a median time of 7 months. During the follow-up, all the patients survived, and there was no tumor recurrence and metastasis. Conclusion Pancreaticojejunostomy with double-layer continuous suture is safe and feasible for TLPD. with advantages of exact anastomosis effect and good application value.
作者
武家成
张学文
杨永生
王禹
方鹤
林瑞新
Wu Jiacheng;Zhang Xuewen;Yang Yongsheng;Wang Yu;Fang He;Lin Ruixin(Department of Hepatobiliary and Pancreatic Surgery,the Second Hospital of Jilin University,Changchun 130041,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2018年第7期746-751,共6页
Chinese Journal of Digestive Surgery
基金
吉林省科技厅社会发展处项目（20170204046SF）
关键词
胰腺肿瘤
胰十二指肠切除术
胰肠吻合
腹腔镜检查
Pancreatic neoplasms
Pancreaticoduodenectomy
Pancreaticojejunostomy
Laparoscopy
