摘要
目的探讨胰十二指肠切除术(PD)中应用肝圆镰状韧带一体化包裹加强技术的临床应用价值。方法回顾性分析哈尔滨医科大学附属肿瘤医院肝胆胰外科2016年1月—2021年12月759例实施开腹PD或保留幽门的胰十二指肠切除术(PPPD)患者的临床资料。根据是否应用肝圆镰状韧带一体化包裹加强技术将患者分为包裹加强组(372例)和无包裹加强组(387例),比较两组患者基本特征、术中资料、术后资料、晚期胰腺术后出血(PPH)资料。结果与无包裹加强组相比,包裹加强组临床相关性胰瘘(CR-POPF)、C级胰瘘、B/C级及C级PPH、晚期PPH、腔外PPH、腹腔感染发生率及腹腔穿刺置管引流率、90天再手术率、PPH相关90天再手术率明显降低(P<0.05),术后住院时间明显缩短(P<0.05)。与无包裹加强组相比,包裹加强组晚期腔外PPH、B/C级及C级晚期腔外PPH发生率、侵入性治疗及再手术率明显降低(P<0.05)。结论肝圆镰状韧带一体化包裹加强技术能够降低PD后CR-POPF、晚期PPH发生率,尤其能够降低C级胰瘘、B/C级及C级晚期腔外PPH发生率,并同时降低腹腔感染、腹腔穿刺置管引流及再手术率,缩短术后住院时间。
Objective The aim of this study was to investigate the clinical application value of the integrated wrapping and reinforcing technique of liver round and falciform ligament in pancreaticoduodenectomy(PD).Methods The clinical data of 759 patients who underwent PD or pylorus-preserving pancreaticoduodenectomy(PPPD)from January 2016 to December 2021 were retrospectively analyzed.According to whether the integrated wrapping and reinforcing technique of the liver round and falciform ligament was used or not,the patients were divided into the wrapping and reinforcing group(372 cases)and the non-wrapping or reinforcing group(387 cases).The basic characteristics,intraoperative data,postoperative data,and late post-pancreatectomy hemorrhage(PPH)data were compared between the two groups.Results The incidences of clinically relevant postoperative pancreatic fistula(CR-POPF),grade C pancreatic fistula,grade B/C and grade C PPH,late PPH,extraluminal PPH,intra-abdominal infection and percutaneous catheter drainage,90-day re-operation,and PPH-related 90-day re-operation were significantly lower in the wrapping and reinforcing group than those in the non-wrapping or reinforcing group(P<0.05).And the postoperative hospital stay was also significantly shortened in the wrapping and reinforcing group(P<0.05).The incidences of late extraluminal PPH,grade B/C and grade C late extraluminal PPH,invasive treatment and re-operation were significantly lower in the wrapping and reinforcing group than those in the non-wrapping or reinforcing group(P<0.05).Conclusion The integrated wrapping and reinforcing technique of the liver round and falciform ligament can reduce the incidence of CR-POPF and late PPH after PD,especially the incidence of grade C pancreatic fistula,grade B/C and grade C late extraluminal PPH.At the same time,it can reduce the rate of intra-abdominal infection,percutaneous catheter drainage and re-operation,and shorten the postoperative hospital stay.
作者
宋增福
赵亮
王鹏
王云峰
赵浩然
张玉宝
SONG Zengfu;ZHAO Liang;WANG Peng;WANG Yunfeng;ZHAO Haoran;ZHANG Yubao(Department of Hepatobiliary and Pancreatic Surgery,Harbin Medical University Cancer Hospital,Harbin 150081,China)
出处
《实用肿瘤学杂志》
CAS
2022年第5期417-423,共7页
Practical Oncology Journal
基金
中国博士后科学基金面上项目(编号:2019M661300)
肝脾外科教育部重点实验室开放基金资助课题(编号:GPFK202003)
哈尔滨医科大学附属肿瘤医院海燕科研基金(编号:JJMS2021-01)。
关键词
肝圆韧带
镰状韧带
包裹
加强
胰十二指肠切除术
Liver round ligament
Falciform ligament
Wrapping
Reinforcement
Pancreaticoduodenectomy
