胰十二指肠切除术后胰管空肠黏膜吻合对胰瘘发生率的影响  

Duct-to-mucosa anastomosis and incidence of pancreatic fistula following pancreaticoduodenectomy

作　　者：韩建明[1] 王新波[1] 全竹富[1] 朱维铭[1] 

机构地区：[1]南京军区南京总医院解放军普通外科研究所,江苏南京210002

出　　处：《医学研究生学报》2009年第9期961-964,共4页Journal of Medical Postgraduates

基　　金：江苏省医学重点人才科研计划基金资助项目(批准号:RC2007121)

摘　　要：目的:胰瘘仍是胰十二指肠切除术后主要的并发症和死亡原因之一,可分为单纯性胰瘘和临床重症胰瘘。回顾性分析表明多种胰肠吻合口重建方式均能降低胰瘘发生率,但极少见前瞻性随机化的临床研究。文中采用前瞻性随机化设计旨在比较胰管空肠黏膜吻合与胰肠套入式吻合对术后胰瘘的影响。方法:64例胰十二指肠切除术患者随机分为胰管空肠黏膜吻合组(A组,n=32例)和胰肠套入式吻合组(B组,n=32例)。所有胰腺残端均为易致胰瘘的软质胰腺。结果:2组病例在基础疾病、病理类型、胰管直径、胰管引流方式等方面没有显著差异。共有21例(32.8%)患者出现手术并发症,其中8例(12.5%)并发胰瘘(胰管黏膜吻合组2例为6.3%,胰肠套入式吻合组6例为18.8%,P>0.05);胰管黏膜吻合组未发生一例有明显临床症状的Ⅱ型重症胰瘘,与胰肠套入式吻合组的4例Ⅱ型胰瘘相比亦无显著差异(0vs12.5%,P=0.057)。胰肠套入式吻合组患者有2例(6.3%)患者再手术。2组病例各有1例死亡(3.1%)。术后住院时间无明显差异(A组为19 d,B组为21 d,P>0.05)。而所有胰瘘患者均经非手术治疗后痊愈。结论:胰管空肠黏膜吻合与胰肠套入式吻合相比,并未显著降低胰十二指肠切除术后临床胰瘘发生率。Objective： Pancreatic fistula, further classified into clinical and subclinical leakage, is a leading cause of morbidity and mortality after pancreaticoduodenectomy. Many techniques have been proposed for the reconstruction of pancreatic digestive continuity, but few prospective randomized studies have been reported on their clinical efficacy. This single-center prospective randomized trial was to compare the results of pancreaticoduodenectomy with duct-to-mucosa versus end-to-side invagination for pancreaticojejunal anastomosis. Methods： A total of 64 patients undergoing pancreaticoduodenectomy were randomized to receive either duct-to-mucosa anastomosis （group A, n = 32） or end-to-side invaginated pancreaticojejunostomy （group B, n = 32）. The pancreatic stumps were soft in all the cases. Results： The two groups were comparable in demographic data, underlying pathology, duct diameter and methods of drainage of the pancreatic duct. There were no significant differences in overall morbidity between groups A （28.1%） and B （37.5%） （P 〉0.05）. Eight （ 12.5% ） of the 64 patients developed pancreatic fistula （6.25% in group A and 18.8% in group B, P 〉 0.05 ）. Group A showed no significant difference from group B in the incidence of pancreatic leakage fistula （0% vs 12.5% , P =0. 057）. Two patients in the invagination group required reoperation. There were no significant differences in post-operative hospital stay （mean 19 d vs 21 d, P 〉0.05） and hospital mortality （both 3.1% ） between the two groups. All the pancreatic fistula patients were cured by non-surgical treatment. Conclusion： The comparative study of the two reconstructive techniques revealed no difference in the incidence of pancreatic fistulas following pancreaticoduodenectomy.

关 键 词：胰十二指肠切除术 胰瘘 胰肠吻合 

分 类 号：R657.5[医药卫生—外科学]