胰十二指肠切除术中胰肠吻合方式的选择策略  

Application of pancreaticojejunostomy procedures selection strategy in pancreaticoduodenectomy

作　　者：张光亚[1] 周景师[1] 李海民[1] 于恒超[1] 王琳[1] 窦科峰[1] 

机构地区：[1]第四军医大学西京医院肝胆胰外科,西安710032

出　　处：《中华消化外科杂志》2013年第2期124-127,共4页Chinese Journal of Digestive Surgery

基　　金：2012年度卫生公益性行业科研专项经费项目（201202007）

摘　　要：目的评价胰肠吻合方式选择策略在胰十二指肠切除术中应用的临床效果。方法回顾性分析2007年6月至2012年6月第四军医大学西京医院收治的455例行胰十二指肠切除术患者的临床资料。对于胰管直径94mm的患者采用胰管空肠黏膜吻合术（胰管空肠黏膜吻合组，210例）；对于胰管直径〈4mm的患者，其胰肠吻合术式由胰腺残端直径和空肠管腔口径决定，空肠管腔口径〈胰腺残端直径者选择改良Child胰肠吻合（改良Child胰肠吻合组，140例），空肠管腔口径≥胰腺残端直径者选用捆绑式胰肠吻合（捆绑式胰肠吻合组，105例）。比较分析各组临床疗效及术后并发症发生率。计数资料采用Ⅳ。检验，计量资料采用t检验。结果胰管空肠黏膜吻合组的胰管直径为（4．4±0．7）mm，显著大于改良Child胰肠吻合组的（2．8±0．6）mm和捆绑式胰肠吻合组的（2．3±0．7）mm（t=2．25，2．48，P〈0．05）。改良Child胰肠吻合组胰腺残端直径为（36±5）mm，显著大于捆绑式胰肠吻合组的（21±6）mm（t=21．65，P〈0．05）。总体胰液漏发生率为8．4％（38／455）。3组患者胰液漏、腹腔出血、腹腔感染、消化功能异常、平均住院时间比较，差异无统计学意义（X2=0．53，0．88，1．63，5．34，F=2．53，P〉0．05）。结论在胰十二指肠切除术中根据胰管直径、胰腺残端直径和空肠管腔口径合理选择胰肠吻合方式可取得较好的临床效果。Objective To evaluate the pancreaticojejunostomy procedures selection strategy in pancreati- coduodeneetomy. Methods The clinical data of 455 patients who received pancreaticoduodeneetomy at the Xijing Hospital from June 2007 to June 2012 were retrospectively analyzed. For patients with pancreatic duct diameter≥4 ram, duct-to-mueosa pancreaticojejunostomy （DMPJ） was applied （DMPJ group, 210 cases）. For patients with pancreatic duct diameter 〈 4 mm, modified Child panereaticojejunostomy was applied to 140 patients （modified Child group） whose jejunal end was smaller than the pancreatic stump, and binding pancreaticojejunostomy was applied to 105 patients （binding group） whose jejunal end was bigger than or equal to the pancreatic stump. The clinical efficacy and incidence of postoperative complications were compared among the 3 groups. The count data and measurement data were analyzed by chi-square test and t test, respectively. Results The pancreatic duct diameter of the DMPJ group was （4.4 ± 0.7 ） ram, which was significantly bigger than （2.8 ± 0.6 ） mm of the modified Child group and （2.3 ± 0.7 ）mm of the binding group （ t = 2. 25, 2. 48, P 〈 0.05 ）. The diameter of the pancreatic stump of the modified Child group was （36±5 ）ram, which was significantly bigger than （21 ±6）mm of the binding group （ t = 21.65, P 〈 0.05 ）. The overall incidence of pancreatic leakage was 8.4% （ 38/455 ）. There were no significant differences in the incidences of pancreatic leakage, peritoneal bleeding, abdominal infec- tion, digestive dysfunction rate and the mean duration of hospital stay among the 3 groups （X2= 0. 53, 0. 88, 1.63, 5.34, F = 2.53, P 〉 0.05）. Conclusion Pancreaticojejunostomy procedure selection strategy based on the diameters of pancreatic duct and pancreatic stump could obtain good clinical efficacy and is appropriate.

关 键 词：壶腹周围肿瘤 胰十二指肠切除术 胰肠吻合 并发症 胰瘘 

分 类 号：R656[医药卫生—外科学]