胰十二指肠切除术中胰肠吻合方式的选择  

Pancreaticojejunostomy procedure selection following pancreaticoduodenectomy

作　　者：薛洪峰[1] 

机构地区：[1]山东省菏泽市立医院胃肠外科,山东菏泽274000

出　　处：《中国普通外科杂志》2013年第9期1132-1134,共3页China Journal of General Surgery

摘　　要：目的：比较胰十二指肠切除术（PD）中应用不同胰肠吻合方式的临床效果。方法：回顾性分析2008年3月-2013年3月收治的260例行PD患者的临床资料，其中胰管直径≥4cm的患者采用胰管空肠黏膜吻合术（135例），胰管直径〈4em的患者，空肠管腔口径〈胰腺残端直径者采用改良Child胰肠吻合（67例）；空肠管腔口径≥胰腺残端直径者采用捆绑式胰肠吻合（58例），比较各组的临床疗效及术后并发症的发生率。结果：所有患者均顺利完成手术，3组患者并发症的发生率如胰瘘、腹腔感染、腹腔出血、消化功能异常及平均住院时间的差异均无统计学意义（均P〉0．05）。1例老年患者术后第4天发生脑血管意外死亡，余患者平均随访3．2（2～4）个月，期间未发现复发、转移及死亡。结论：在PD术中应依据胰管直径、胰腺残端直径及空肠管腔VI径选择胰肠吻合方式，恰当的胰肠吻合方式可取得良好的临床疗效。Objective： To compare the clinical efficacy of the different pancreatico-enteric anastomosis procedures after pancreaticoduodenectomy （PD）. Methods： The clinical data of 260 patients undergoing PD from March 2008 to March 2013 were retrospectively analyzed. The patients with pancreatic duct diameter ≥4 cm underwent duct-to-mucosa pancreaticojejunostomy （135 cases）; of the patients with pancreatic duct diameter 〈4 cm, the cases with jejunal lumen less than the size of pancreatic stump underwent modified Child pancreaticojejunostomy （67 cases）, while the cases with jejunal lumen equal or greater than the size of pancreatic stump underwent binding pancreaticojejunostomy （58 cases）. The clinical efficacy and incidence of postoperative complications among the three groups were compared. Results： The operations were completed in all patients. The incidence of postoperative complications such aspancreatic juice leakage, abdominal infection, intra-abdominal hemorrhage and digestive dysfunction as well as the average length of hospital stay among the three groups showed no statistical difference （all P〉0.05）. One elderly patient died of cerebrovascular accident on the fourth day after operation, and the remaining patients were followed up for 3.2 （2-4） months, during which time no recurrence, metastasis or death occurred. Conclusion： The procedure ofpost-PD pancreatico-enteric anastomosis should be selected according to the pancreatic duct diameter and size of the pancreatic stump as well as the size of the jejunal lumen. The proper post-PD pancreatico-enteric anastomosis could yield favorable results.

关 键 词：胰十二指肠切除术 胰管空肠吻合术 方法 手术后并发症 

分 类 号：R657.5[医药卫生—外科学]