捆绑式胰胃吻合术在中段胰腺切除术中的应用价值  

Clinical application of binding pancreaticogastrostomy in the central pancreatectomy

作　　者：康鹏程[1] 姜兴明[1] 万明[1] 李春龙[1] 钟翔宇[1] 王志东[1] 邰升[1] 崔云甫[1] 

机构地区：[1]哈尔滨医科大学附属第二医院胆胰外科,150086

出　　处：《中华消化外科杂志》2015年第11期921-924,共4页Chinese Journal of Digestive Surgery

基　　金：黑龙江省科技厅攻关项目（GC12C304-1）

摘　　要：目的探讨捆绑式胰胃吻合术（BPG）在中段胰腺切除术（cP）中的应用价值。方法回顾性分析2010年1月至2014年10月哈尔滨医科大学附属第二医院收治的62例行CP并采用BPG进行重建的胰腺颈体部良性及低度恶性疾病患者的临床资料。其中56例患者为胰腺颈体部占位性病变：胰腺实性假乳头状瘤21例，胰腺神经内分泌肿瘤19例（其中13例为无功能性胰岛细胞瘤），胰腺囊腺瘤16例（其中浆液性囊腺瘤12例、黏液性囊腺瘤4例），均经术后病理学检查结果证实；6例为胰腺颈体部破裂伤。手术方式采用CP联合BPG。手术探查后，联合应用上入路和前入路切除胰腺中段；采用BPG进行消化道重建。记录患者手术时间、术中出血量、术后胃肠功能恢复时间、术后拔除引流管时间、术后住院时间及术后并发症情况。采用门诊和电话方式进行随访，随访内容包括患者血糖情况、胰腺外分泌功能情况及是否有胰腺假性囊肿形成等。随访时间截至2015年1月。结果62例患者均顺利完成手术，无围术期死亡患者。平均手术时间为155mirl（125—230min），平均术中出血量为300mL（210～425mL），平均术后胃肠功能恢复时间为3．0d（2．0～5。0d），平均术后拔除引流管时间6．0d（4．0—10．0d），平均术后住院时间为10．5d（9．0～21．0d）。7例患者术后发生胃排空延迟，均经非手术治疗后痊愈。6例患者术后发生胰瘘，其中4例患者（均为A级）于住院期间愈合，2例患者（均为B级）带引流管出院，影像学检查证实胰瘘愈合后拔除引流管。2例患者术后发生出血，其中1例消化道出血行胃镜下烧灼止血，另1例腹腔出血行剖腹探查止血。所有患者获得随访，随访时间为3—36个月，中位随访时间为25个月。随访期间，无患者出现血糖增高、胰腺外分泌功能不足及胰腺假性囊肿形成。结论cP创伤小�Objective To investigate the clinical application of binding pancreaticogastrostomy （BPG） in the central pancreatectomy （CP）. Methods The clinical data of 62 patients with benign and low-grade malignant lesions in the neck and body of pancreas who received CP combined with BPG from January 2010 to October 2014 were retrospectively analyzed. Fifty-six patients with space-occupying lesions of the head and neck of pancreas were confirmed by postoperative pathological examinations, including 21 solid pseudopapillary tumors of pancreas （ SPTPs）, 19 pancreatic neuroendocrine neoplasms （PNENs） （ 13 non-functional islet cell tumors）, 16 pancreatic cystic tumors （12 serous cystadenomas and 4 mucinous cystadenomas） and 6 ruptures in the head and neck of pancreas. CP combined with BPG was performed. The central pancreas was resected via upper and anterior approaches after surgical exploration, and digestive tract reconstruction was applied using BPG. The operation time, volume of intraoperative blood loss, time of postoperative gastrointestinal function recovery, drainage tube removed time, duration of hospital stay and postoperative complications were recorded. Patients were followed up by outpatient examination and telephone interview up to January 2015, and follow-up included the level of blood glucose, conditions of pancreatic exocrine function and with or without pancreatic pseudocyst. Results All the patients underwent successful operation without perioperative death. The average operation time, average volume of intraoperative blood loss, average time of postoperative gastrointestinal function recovery, average drainage tube removal time and average duration of postoperative hospital stay were 155 minutes （range, 125-230 minutes）, 300 mL （range, 210-425 mL）, 3.0 days （range, 2.0-5.0 days）, 6.0 days （range, 4.0-10.0 days） and 10.5 days （range, 9.0-21.0 days）, respectively. Seven patients with delayed gastric emptying were cured by non-surgical treatment. Of 6 patients compl

关 键 词：胰腺肿瘤 胰腺损伤 中段胰腺切除术 捆绑式胰胃吻合 胰瘘 

分 类 号：R657.5[医药卫生—外科学]