袖套式胰肠吻合术在消化道重建中的应用价值  

Application value of sleeve pancreaticojejunostomy in digestive tract reconstruction

作　　者：罗程[1] 陈琪[1] 贺凯[1] 薛钰婷[1] 苏松[1] 张光年[1] 夏先明[1] 李波[1] 

机构地区：[1]泸州医学院附属医院肝胆外科,646000

出　　处：《中华消化外科杂志》2015年第11期916-920,共5页Chinese Journal of Digestive Surgery

基　　金：四川省科技厅联合泸州市科技局泸州医学院附属第一医院资助项目（201410）

摘　　要：目的探讨袖套式胰肠吻合术在}肖化道重建中的应用价值。方法回顾分析2013年7月至2015年2月泸州医学院附属医院收治的40例行袖套式胰肠吻合术患者的临床资料。手术方式行根治性胰十二指肠切除术。采用Kouch手法游离出胰头与十二指肠降部，断面做连续U形的编织样缝合封闭细小胰管，常规进行胰腺断端后壁与空肠壁的缝合，主胰管置入硅胶支撑管固定并保留线头，预留线于空肠壁开口6点及12点方位穿出缝合打结，空肠黏膜如同袖套自然套在主胰管表面，缝合固定胰腺断端前壁，完成胰肠吻合。观察患者术中情况。监测患者术后1、3、5、7d的引流液淀粉酶变化。术后患者每3个月返院复查肝功能、肿瘤标志物、腹部彩色多普勒超声，每6个月复查腹部增强cT，随访时间截至2015年5月。偏态分布的计量资料用时（Qn）表示，采用秩和检验。正态分布的计量资料用膏±s表示。重复测量数据采用重复测量的方差分析。结果40例患者顺利完成手术，胰肠吻合方式均采用袖套式胰肠吻合。40例患者手术时间为（6．2±1．3）h，其中胰肠吻合时间为（15±6）min，术中出血量为（370±55）mL，肿瘤直径为（2．5±1．5）cm。术后1d引流液淀粉酶为46．300U（35．575U，68．600U），术后3d淀粉酶检测值为34．900U（21．050U，55．550U），术后5d淀粉酶检测值为26．750U（0．000U，41．400U），术后7d淀粉酶检测值为0．000U（0．000U，30．500U），随着时间的延长，引流液淀粉酶逐渐减少（F=97．268，P〈0．05）。40例患者中有2例出现了吻合口引流液淀粉酶升高，但引流液量未达到50mL／d，而且体温正常，无腹痛及腹膜炎体征，考虑胰液漏可能，经过对症支持治疗后痊愈。其余患者未发现吻合口漏或出血等并发症。40例患者住院时间为（18±5）d。39例患者获得随访，随访时间为3～15个�Objective To investigate the application value of sleeve panereaticojejunostomy in digestive tract reconstruction. Methods The clinical data of 40 patients who underwent sleeve pancreaticojejunostomy at the Affiliated Hospital of Luzhou Medical College between July 2013 and February 2015 were retrospectively analyzed. The head of pancreas and duodenal descending part were drifted out through Koueh technique, sections were sutured in braid-like U shape and the small pancreatic ducts were closed. The posterior wall of pancreatic stump and jejunal wall were sutured routinely and main pancreatic tube was implanted by silica gel with the thrum retained. The reserved lines were gone through at 6 o＇clock and 12 o＇clock in the jejunal wall to be sutured and knotted, making the jejunal mueosa set on the surface of main pancreatic duct like sleeve, and then the anterior wall panereatie stump was sutured. The intraoperative situation and amylase concentration of drainage at post- operative day 1, 3, 5, 7 were observed and monitored. The patients were followed up for liver function, tumor markers, abdominal color Doppler ultrasound every 3 months and enhanced abdominal computer tomography every 6 months till May 2015. Measurement data with skewed distribution were presented as M（Qn） and analyzed by rank-sum test. Measurement data with normal distribution data were presented as x ± s. Repeated measurement data were analyzed by the repeated measures ANOVA. Results All the 40 patients underwent sleeve pancreatico- jejunostomy successfully. The duration of operation and pancreaticojejunostomy were （6.2 ± 1.3） hours and （ 15 ± 6） minutes, respectively. The volume of intraoperative blood loss was （370 ± 55 ） mL and diameter of tumor was （2.5± 1.5 ）cm. The amylase concentrations of drainage at postoperative day 1,3,5, 7 were 46.300 U （35. 575 U, 68.600 U）, 34.900 U （21.050 U, 55. 550 U）, 26. 750 U （0. 000 U, 41. 400 U） and 0. 000 U（0. 000 U, 30. 500 U）, showing decrease trend with the ti

关 键 词：胆胰疾病 胰十二指肠切除术 袖套式胰肠吻合 

分 类 号：R656[医药卫生—外科学]