胰十二指肠切除套入式胰肠吻合术后胰管流出道狭窄的危险因素分析  

Risk factors of pancreatic duct strictures after pancreatiocoduodenectomy

作　　者：张铃福[1] 陶明[1] 彭颖[1] 李磊[1] 原春辉[1] 马朝来[1] 蒋斌[1] 修典荣[1] 

机构地区：[1]北京大学第三医院普通外科,100191

出　　处：《中华普通外科杂志》2015年第5期357-360,共4页Chinese Journal of General Surgery

摘　　要：目的 分析胰十二指肠切除端端套入式胰肠吻合术后胰管流出道狭窄发生情况及危险因素.方法 前瞻性收集35例胰十二指肠切除术患者的临床病例资料,其中7例出现胰管流出道狭窄.依据增强CT测定胰管的直径;规定胰管直径差为术后胰管直径减术前胰管直径,胰管直径差＞1.0mm为胰管流出道狭窄;按有无胰管流出道狭窄分为两组. 结果 本组患者术前胰管直径（4.2±2.4） mm（1.0～10.0 mm）,胰管直径＜3.0 mm的15例.单因素分析示总胆红素（P =0.028）、碱性磷酸酶（P =0.036）、术前胰管直径（P=0.007）在两组之间差异有统计学意义,多元线性回归分析示术前胰管直径是胰管直径差的独立危险因素（P＜0.001）,相关性分析示术前胰管直径与胰管直径差呈线性负相关.结论 胰十二指肠切除端端套入式胰肠吻合术后胰管流出道狭窄发生率不低,术前胰管直径是独立危险因素.Objective To Analyze the prevalence and risk factors of outflow tract strictures of the pancreatic duct after pancreatiocoduodenectomy using end-to-end invagination pancreaticojejunostomy.Methods The clinical data of 35 patients undergoing pancreatiocoduodenectomy was prospectively collected and analyzed.Among them 7 cases suffered from outflow tract strictures of the pancreatic duct.The diameter of the pancreatic duct was measured by enhanced CT.The postoperative pancreatic duct diameter reduction greater than 1.0 mm is termed as outflow tract stricture of the pancreatic duct.The two groups with or without outflow tract strictures were compared.Results The pancreatic duct diameter before operation was （4.2 ± 2.4） mm（1.0-10.0mm）,15 cases of them were less than 3.0 mm.Total bilirubin （P =0.028）,alkaline phospatase （P =0.036） and preoperative pancreatic duct （P =0.007） demonstrated statistically significant differences between cases of outflow tract strictures and those without strictures.Multivariable linear regression return analysis shows that preoperative pancreatic duct diameter is the independent risk factor for pancreatic duct diameter variation after pancreaticojejunostomy （P 〈 0.001）.Furthermore,correlation analysis exhibited a linear negative correlation between preoperative pancreatic duct diameter and the pancreatic duct diameter variation.Conclusions Outflow tract stricture of the pancreatic duct is not rare after pancreatiocoduodenectomy using end-to-end invagination pancreaticojejunostomy,preoperative pancreatic duct diameter is an independent risk factor.

关 键 词：胰十二指肠切除术 吻合术 外科 

分 类 号：R657.5[医药卫生—外科学]