根据胰管直径等因素选择不同胰肠吻合方式对患者术后恢复的影响  

Effects of different procedures of pancreaticojejunostomy selected based on pancreatic duct diameter and other factors on postoperative recovery

作　　者：陈炜[1] 冯春林[1] 主鹤亭[1] 

机构地区：[1]遵义医学院第三附属医院肝胆外科,贵州省遵义市563002

出　　处：《世界华人消化杂志》2015年第11期1844-1848,共5页World Chinese Journal of Digestology

摘　　要：目的:探究根据胰管直径等因素选择不同胰肠吻合方式对患者术后恢复的影响.方法:采取回顾性的方法对2010-01/2014-01遵义医学院第三附属医院接收治疗的进行胰十二指肠切除术的108例患者的临床资料进行分析.其中胰管直径≥3 mm的患者42例,给予其胰管空肠黏膜吻合术进行治疗,为胰管空肠黏膜吻合组.胰管直径<3 mm的患者66例,其中28例患者的胰腺残端比较粗大,且较空肠管径大的患者给予改良Child胰肠吻合术进行治疗,为改良Child胰肠吻合组,其余38例患者胰腺残端直径<空肠管径,给予其套入加捆绑式胰肠吻合术进行治疗,为套入加捆绑式胰肠吻合组.对比不同胰肠吻合方式患者的术后并发症发生率,并对其临床疗效进行评价.结果:3组患者中胰管空肠黏膜吻合组患者的胰管直径最大,与其他两组相比较差异具有统计学意义(P<0.05).3组患者中改良Child胰肠吻合组患者的胰腺残端直径最大,与其他两组相比较差异具有统计学意义(P<0.05).比较3种手术方式的术中出血量、胰肠吻合时间、手术总时间之间的差异不具有统计学意义(P>0.05).3组患者共发生9例胰瘘,总胰瘘发生率为8.33%.比较3组患者的术后腹腔出血、胰瘘、消化功能异常、腹腔感染、死亡和平均住院时间差异无统计学意义(P>0.05).结论:在进行Wipple术时,根据患者的胰管直径、空肠管径和胰腺残端直径选择合理的胰肠吻合方式对患者术后的恢复有一定的促进作用.AIM： To assess the effects of different procedures of pancreaticojejunostomy selected based on pancreatic duct diameter and other factors on postoperative recovery.METHODS： A retrospective analysis was performed of the clinical data for 108 patients who underwent pancreaticojejunostomy at the Third Affiliated Hospital of Zunyi Medical College from January 2010 to January 2014. For patients with a pancreatic duct diameter ≥ 3 mm（n = 42）, pancreaticojejunostomy was adopted（group A）. There were 66 patients with a duct diameter 〈 3 mm, of whom 28 had a relatively thick pancreatic stump larger than the diameter of the jejunum and received the modified Child pancreaticojejunostomy（group B）, and the remaining 38 with a pancreatic stump diameter smaller than the diameter of the jejunum received binding pancreaticojejunostomy（group C）. The rate of postoperative complications and clinical efficacy were compared for the two groups.RESULTS： The pancreatic duct diameter was significantly larger in group A than in groups B and C（P 〈 0.05）, while the pancreatic stump was the largest in group B, significantly larger than the other two groups（P 〈 0.05）. The total time of surgery was not statistically significant among the three groups（P 〉 0.05）. There were nine cases of pancreatic fistula in all of the patients, and the total rate of pancreatic fistula was 8.33%. The rates of postoperative abdominal bleeding, pancreatic fistula, digestive dysfunction, abdominal infection, death, and the average length of stay were not statistically significant among the three groups（P 〉 0.05）.CONCLUSION： Selection of pancreaticojejunostomy based on the patient’s pancreatic duct diameter, jejunum diameter and the diameter of the pancreatic stump is a reasonable way.

关 键 词：胰十二指肠切除术 胰管直径 胰肠吻合方式 术后恢复 

分 类 号：R473.73[医药卫生—护理学]