胰十二指肠切除术不同胰肠吻合方式胰漏分析  

Incidence of pancreatic anastomotic lekage in two different methods of pancreaticoduodenectomy

作　　者：丁会民[1] 秦锡虎[1] 朱峰[1] 周新军[1] 

机构地区：[1]苏州大学附属三院,常州市第一人民医院肝胆外科,213000

出　　处：《中华普通外科学文献（电子版）》2008年第3期24-27,共4页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的探讨胰十二指肠切除术(PD)不同胰肠吻合方式对胰漏发生的影响。方法回顾2002年2月至2007年5月154例行胰十二指肠切除术病例,分别采取胰肠套埋单层吻合105例,双层吻合49例,分析与胰漏相关危险因素及两组间胰漏差异原因。结果胰漏发生率8.4%(13/154),Logistic回归多变量分析表明:男性、胰腺质地软、非单层胰肠吻合方式是3个与胰瘘相关的独立变量;两种吻合方式间胰漏(单层吻合,4.8%vs双层吻合,16.4%)、术后并发症(单层吻合,18.1%vs双层吻合,32.7%)、术后平均住院时间(单层吻合,18.45±7.11天vs双层吻合,22.75±9.73天)、质软胰腺中胰漏(单层吻合,6%vs双层吻合,27.6%)有统计学差异。结论胰肠套埋单层吻合,特别是在质软胰腺中应用可明显减少胰漏发生率。Objective To analyze the possible difference in the incidence of pancreatic leakage relative to two methods of pancreaticoduodenectomy（PD）. Methods A retrospective review of 154 consecutive patients who underwent PD between Feb 2002 and May 2007 was carried out. 105 cases were used a single-deck invaginated pancreaticojejunostomy, 49 cases were double-deck invaginated.Risk factors associated with leakage were determined for all 154 cases and then outcomes for each group were compared. Results Leakage was observed inl3 of 154 cases （8.4%）.Uni-and multivariate analysis showed three independent risk factors for leakage ： male gender; not using a single-deck invaginated pancreaticojejunostomy; soft pancreatic gland.The leakage rate in the single-deck group was 4.8% （5 of 105）and in the double-deck group was 16.4%（8 of 49,P=0.016）.The postoperation complication was 18.1% in single-deck group while 32.7% in the double-deck group.The mean length of stay after PD was longer in the double-deck group （22.75 ± 9.73 days）as compared to the single-deck group （18.45 ± 7.11 days）. The leakage rate was 6% in the single-deck group vs 27.4% in the double-deck group （P=0.014）. Conclusion The single-deck invaginated pancreaticojejunostomy decreases leakage significantly, particularly when a patient has soft pancreatic gland.

关 键 词：胰十二指肠切除术 胰漏 吻合方式 

分 类 号：R656[医药卫生—外科学]