胰十二指肠切除术技术改进的临床研究  

Clinical Investigation of Technical Improvement for Pancreaticoduodenectomy

作　　者：曾海锋[1] 黄擎雄[1] 冯平[1] 吴志扬[1] 郑小明[1] 刘臻玉[1] 

机构地区：[1]广东省肇庆市第一人民医院普外科,肇庆526021

出　　处：《中国现代手术学杂志》2008年第1期16-19,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的评价胰十二指肠切除术(pancreaticoduodenectomy,PD)技术改进后的效果。方法采用病例对照研究,对比传统组30例及改良组28例的临床资料、手术相关指标和术后并发症发生率。传统组采用传统PD方式手术,而改良组采用PPPD术式,探查时先离断胆管,直接显露PV及SMV;胆胰内引流;胰肠吻合采用套入式单层吻合法。结果改良组在探查时间、胰肠吻合时间、手术时间、术中出血量、术后住院天数、住院费用上明显优于传统组(P<0.05或P<0.01),术后改良组发生胰瘘1例(3.6%),明显优于传统组的7例(23.3%)(P<0.05)。但改良组术后发生胃排空障碍6例(21.4%),明显多于传统组1例(3.3%),经保守治疗后均获缓解。术后改良组死亡1例(3.6%),与传统组4例(13.3%)比较无差异(P>0.05)。结论PD改良术能降低胰瘘发生率,缩短手术时间,降低住院费用,值得临床推广。Objective To evaluate the efficacy and clinical significance of the improved technique of pancreaticoduodenectomy（PD）.Methods Case control study was applied,in which 30 patients（Group A） underwent traditional PD,and 28（Group B） underwent improved（pylorus-preserving pancreaticoduodenectomy,PPPD）.The technical improvements in Group B were to use the exploration sequence which had priority over PV and SMV revealing,to abandon bilio-pancreatic external drainage,and to complete the pancreaticojejunostomy with monolayer sewing after the pancrease was emboliaed into the jejunum.Results The operative related indexes were significantly better in Group B than those in Group A,such as exploration time,pancreaticojejunostomy time,bleeding volume during operation,operative time,hospital stay after surgery,and hospitalization cost（P〈0.05 or P〈0.01）.In Group A,the pancreatic fistula rate was higher than that of Group B,23.3% VS 3.6%（P〈0.05）,but the delayed gastric emptying rate was lower,3.3% VS 21.4%（P〈0.05）.And there was no difference of the post-operative mortality,with 13.3% of Group A,and 3.6% of Group B（P〉0.05）.Conclusion With the advantages of decreased pancreatic fistula,shorten time of operation and reduced hospitalization cost,the improved technique of PD are deserving to be spread.

关 键 词：胰十二指肠切除术 

分 类 号：R735.9[医药卫生—肿瘤]