改良单层胰肠吻合术在胰十二指肠切除术带蒂大网膜包埋中的应用  

Pancreaticoduodenal Resection of Improving Pedicle Greater Omentum Embedding in Single Application Experience of Pancreatic Anastomosis

作　　者：钱宁[1] 李可为[1] 沈火剑[1] 朱宏毅[1] 胡竑韡 

机构地区：[1]上海交通大学医学院附属仁济医院普外科,上海200127

出　　处：《现代生物医学进展》2015年第33期6458-6461,共4页Progress in Modern Biomedicine

基　　金：上海市科委基金项目(004119009)

摘　　要：目的:探讨带蒂大网膜包埋的改良单层胰肠吻合法重建消化道的胰十二指肠术的临床疗效。方法:回顾性分析2012年9月-2014年12月在我院行胰十二指肠切除术带蒂大网膜包埋改良单层胰肠吻合术的34例患者的临床资料。统计患者的手术时间、胰肠吻合时间、术后出血量、住院时间以及并发症的发生情况。结果:(1)手术平均时间(2.9±1.4)h,胰肠吻合平均时间(14±2.1)min,术后平均出血量(380±60)m L。所有患者经治疗后均治愈出院,住院时间平均(13.0±2.4)天。(2)术后并发症发生率为8例(23.5%),其中胰瘘2例(5.8%),为A级胰瘘;腹部感染3例(8.8%);腹腔出血2例(5.8%);胃排空延迟1例(2.9%)。无手术死亡者,无因严重并发症需要再次手术者。术后病理学诊断胰头癌18例,胆总管下癌8例,壶腹部癌5例,十二指肠乳头癌3例。结论:带蒂大网膜包埋的改良单层胰肠吻合能够减少术后胰瘘、出血、感染等并发症,提高手术成功率,值得临床进一步推广。Objective： To explore the clinical effect of improved single pancreatic anastomosis method with pedicle greater omentum embedding in the reconstruction of digestive tract of pancreatic duodenal decompression. Methods： The clinical data of 34 patients with improved single layer anastomosis of pancreas and duodenum who were treated in our hospital from September 2012 to December 2014 were retrospectively analyzed. Then the operation time, blood loss, time of the anastomosis, the hospitalization and postoperative complications were analyzed, Results： （1）The average time of operation was （2.9 ± 1.4） h, the average time of the anastomosis was （14± 2.1） rain, and the average bleeding volume was （380± 60） mL. All patients were cured and discharged after the treatment, and the average length of hospital stay was （13±2.4） days. （2）The incidence of postoperative complications was observed in 8 cases （23.5%）, including 2 cases of pancreatic fistula （5.8%） classified in A grade, 3 cases of abdominal infection （8.8%）, 2 cases of abdominal cavity hemorrhage （5.8%）, 1 case of delayed gastric emptying （2.9%）. There were not patients died because of the operation or required reoperation because of serious complications. Pathological diagnosis after the operation included 18 cases of pancreatic head carcinoma 8 cases of bile duct carcinoma, 5 cases of carcinoma of the stomach and 3 cases of duodenal papilla carcinoma. Conclusions： The improved single pancreatic anastomosis method with pedicle greater omentum embedding can reduce postoperative complications such as pancreatic fistula, bleeding, infection and so on, improve the success rate of operation, so it is worthy of clinical promotion.

关 键 词：大网膜包埋 胰肠吻合 胰十二指肠术 疗效 

分 类 号：R657.5[医药卫生—外科学] R735.9[医药卫生—临床医学]