摘要
目的:比较改良胰肠吻合与普通胰肠吻合在胰十二指肠切除术中的应用效果。方法:将2014年1月—2015年11月采用普通胰肠吻合进行消化道重建的79例壶腹周围肿瘤患者(普通胰肠吻合组)临床资料与2015年12月—2017年12月采用改良胰肠吻合进行消化道重建87例壶腹周围肿瘤患者(改良胰肠吻合组)临床资料行进行回顾性历史对照分析,普通胰肠吻合为用胰腺断端-空肠侧壁吻合,改良胰肠吻合为胰腺断端-空肠侧壁黏膜对黏膜吻合。比较两组的相关临床指标。结果:两组患者基本资料、手术方式、整体手术时间和术中失血量的差异无统计学意义(均P>0.05),尽管两组整体手术时间无统计学差异,但改良胰肠吻合所用的时间约为普通胰肠吻合时间的2倍。改良胰肠吻合组术后A级和B级胰瘘发生率明显低于普通胰肠吻合组(P=0.027、0.019),胆瘘和腹腔感染的发生率也明显低于普通胰肠吻合组(P=0.014、0.011),两组的术后并发症中C级胰瘘、肠瘘、腹腔出血和胃排空延迟发生率无统计学差异(均P>0.05)。结论:改良胰肠吻合和普通胰肠吻合比较,可显著降低A级、B级胰瘘、胆瘘和腹腔感染的发生率,但手术时间有所延长,该改良术式值得进一步在临床应用。
Objective： To compare the clinical efficacy of modified pancreaticojejunostomy versus conventional pancreaticojejunostomy in pancreaticoduodenectomy. Methods： Using a retrospective historical approach, the clinical data of 79 patients with periampullary tumors undergoing conventional pancreaticojejunostomy for digestive tract reconstruction （conventional pancreaticojejunostomy group） from Jan 2014 to Nov 2015, and 87 patients with periampullary tumors undergoing modified pancreaticojejunostomy for digestive tract reconstruction （modified pancreaticojejunostomy group） from Dec 2015 to Dec 2017, were analyzed. The conventional pancreaticojejunostomy was end-to-side anastomosis between the remnant pancreas and lateral jejunal wall, and the modified pancreaticojejunostomy was mucosa-to-mucosa anastomosis between the remnant pancreas and lateral jejunal wall. The main clinical variables between the two groups were compared. Results： There were no significant differences in general data, surgical procedures, overall operative time, and intraoperative blood loss between the two groups （all P〉0.05）. Despite the similar overall operative times between the two groups, the time for pancreaticojejunostomy in modified pancreaticojejunostomy group was two times of that in conventional pancreaticojejunostomy group. The incidence of grade A or B pancreatic fistula in the modified pancreaticojejunostomy group was significantly lower than that in conventional pancreaticojejunostomy group （P=0.027 and 0.019）, and the incidence of biliary fistula or abdominal infection was also significantly lower than that in conventional pancreaticojejunostomy group （P=0.014 and 0.011）. The incidence of grade C pancreatic fistula, intestinal fistula, intra-abdominal bleeding, and delayed gastric emptying showed no statistical differences between the two groups （all P〉0.05）. Conclusion： Compared with the conventional pancreaticojejunostomy, the modified pancreaticojejunostomy offers reduced incidence of grade A and B pancreatic fistula, biliary fistula and abdominal infection. Although this modified procedure has somewhat prolonged operative time, it is recommended to be further used in clinical practice.
作者
周辉年
俞泽元
杨含腾
张树泽
任彦先
王科深
焦作义
ZHOU Huinian, YU Zeyuan, YANG Hanteng, ZHANG Shuze, REN Yanxian, WANG Keshen, JIAO Zuoyi(Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2018年第9期1095-1101,共7页
China Journal of General Surgery
关键词
胰十二指肠切除术
胰管空肠吻合术
手术后并发症
胰腺瘘
Pancreaticoduodenectomy
Pancreaticojejunostomy
Postoperative Complications
Pancreatic Fistula
