中国普外基础与临床杂志

中国普外基础与临床杂志

胰十二指肠切除术中胰管-空肠对黏膜三层吻合与胰肠套入式吻合后吻合口瘘的比较研究

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目的 对比研究胰十二指肠切除术(PD)中采用胰管-空肠黏膜对黏膜三层吻合(简称三层吻合)与胰腺-空肠端端套入式吻合(简称套入式吻合)后的吻合口瘘发生情况。 方法 回顾性分析四川大学华西医院胰腺外科 2015 年 1 月至 2017 年 6 月期间收治的 147 例行 PD 患者的临床资料,根据术中采用的吻合方式分为三层吻合组和套入式吻合组,比较 2 组患者的术中情况及术后并发症尤其是吻合口瘘的发生情况。 结果 本研究 147 例 PD 患者中三层吻合组 101 例,套入式吻合组 46 例,2 组患者的基线资料比较差异均无统计学意义(P>0.05)。2 组患者除三层吻合组的胰肠吻合时间明显长于套入式吻合组(t=3.016,P=0.005)外,2 组患者的术中出血量、术后首次肛旆排气时间、术后住院时间、术后再手术率、术后死亡率以及并发症如胰瘘、胆瘘、吻合口出血、胃排空障碍、腹腔感染及腹腔出血率比较差异均无统计学意义(P>0.05)。 结论 胰管-空肠黏膜对黏膜三层吻合与胰腺-空肠端端套入式吻合同样安全、有效,应根据患者的具体情况采用个体化选择。

Objective To compare anastomotic fistula of modified triple-layer duct-to-mucosa pancreaticojejunostomy and end-to-end invagination pancreaticojejunostomy following pancreaticoduodenectomy. Methods The clinical data of 147 patients underwent pancreaticoduodenectomy from January 2015 to June 2017 in the West China Hospital of Sichuan University were retrospectively analyzed. The modified triple-layer duct-to-mucosa pancreaticojejunostomy were used in 101 cases (MTL group) and end-to-end invagination pancreaticojejunostomy were used in 46 cases (IPJ group). The differences of intraoperative and postoperative statuses were compared between the two groups. Results The baseline data of these two groups had no significant differences (P>0.05). Except for the average time of the pancreaticoenterostomy of the MTL group was significantly more than that of the IPG group (P<0.05), the intraoperative blood loss, the first postoperative exhaust time, postoperative hospitalization time, reoperation rate, death rate, and rates of complications such as the pancreatic fistula, biliary fistula, anastomotic bleeding, gastric emptying disorder, and intraperitoneal infection had no significant differences between these two groups (P>0.05). Conclusions Both modified triple-layer duct-to-mucosa pancreaticojejunostomy and end-to-end invagination pancreaticojejunostomy following pancreaticoduodenectomy are safe and effective. An individualized selection should be adopted according to specific situation of patient.

关键词: 胰十二指肠切除术; 胰肠吻合方法; 术后相关并发症; 胰瘘

Key words: pancreaticoduodenectomy; pancreaticojejunostomy; postoperative complications; pancreatic fistula

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