胰胃和胰肠吻合对保留幽门胰十二指肠切除术后近期并发症影响的对比研究  

Early complications of pancreaticojejunostomy or pancreaticogastrostomy after pylorus preserving pancreaticoduodenectomy

作　　者：童汉兴[1] 王单松[1] 匡天涛[1] 吴文川[1] 许雪峰[1] 楼文晖[1] 靳大勇[1] 

机构地区：[1]复旦大学附属中山医院普外科,上海200032

出　　处：《中华普通外科杂志》2014年第5期334-336,共3页Chinese Journal of General Surgery

摘　　要：目的比较胰胃和胰肠吻合对保留幽门的胰十二指肠切除术后近期并发症的影响。方法回顾性分析复旦大学附属中山医院2011年6月至2012年10月间97例保留幽门的胰十二指肠切除术患者临床资料，包括胰胃吻合52例，胰肠吻合45例，比较两组术后并发症发生的差异。结果两组术后主要并发症如胆瘘、腹腔感染、出血及再入院率差异均无统计学意义（均P〉0．05）。胰瘘发生率（B级以上），胰胃吻合组少于胰肠吻合组（6．67％比28．85％，P=0．033）；术后胃排空延迟发生率，胰胃吻合组高于胰肠吻合组（22．22％比5．77％，P=0．018），平均住院时间胰胃吻合组长于胰肠吻合组（19．28±11．04d比15．09±6．21d，P=0．034）。胰肠吻合组中1例因术后胰瘘，致腹腔感染和出血死亡，胰胃吻合组无死亡病例。结论保留幽门的胰十二指肠切除术，采用胰肠和胰胃吻合均是安全的。胰胃吻合可降低胰瘘发生率，但有可能增加术后胃排空延迟发生率，从而延长住院时间。Objective To evaluate the early postoperative complications of pancreaticojejunostomy （ PJ ） or pancreatieogastrostomy （ PG ） following pylorus preserving pancreaticoduodenectomy （ PPPD ）. Methods Clinical data of 97 patients undergoing PPPD, in Zhongshau Hospital, Fudan University from June 2011 to October 2012, were retrospectively analyed. Digestive tract continuity was established respectively by PG（ n = 45 ） or PJ （ n = 52 ） after PPPD. Results The demographic characteristics of both group were not significantly different. In the two groups, there were not statistically significant difference in those postoperative complications such as biliary fistula, introabdominal infection, bleeding, and the re-admission rate. The rate of pancreatic fistula in PJ group was significantly higher than that in the PG group （28.85% vs. 6.67% , P =0. 033）. However, in PG group the incidence of delayed gastric emptying was significantly higher than that in the PJ group （22.22% vs. 5.77% , P =0. 018）, and the average length of stay was significantly longer than that in PJ group （ 19.28 ± 11.04 vs. 15.09 ±6. 21 ; P =0. 034）. In PJ group, one patient died of pancreatic fistula and ensuing surgical site infection and intra-abdominal hemorrhage, there was no mortality in PG group. Conclusions After PPPD, PG and PJ are both safe ways of digestive tract reconstruction. But compared to PJ, PG can deereas the rate of pancreatic fistula but may increase the risk of postoperative delayed gastric emptying, and prolong postoperative hospital stay.

关 键 词：胰十二指肠切除术 吻合术 外科 手术后并发症 

分 类 号：R656[医药卫生—外科学]