改良降落伞式胰管空肠吻合法在胰十二指肠切除术中的临床应用分析  

Clinical application of modified parachute-like pancreaticojejunostomy for pancreatoduodenectomy

作　　者：周振宇[1] 胡志刚[1] 何传超[1] 张建龙[1] 肖治宇[1] 李文滨[2] 孙健[2] 王捷[1] 

机构地区：[1]中山大学孙逸仙纪念医院肝胆外科,广州510120 [2]中山大学孙逸仙纪念医院胆胰外科,广州510120

出　　处：《中国医师杂志》2015年第12期1776-1780,共5页Journal of Chinese Physician

基　　金：广东省科技计划资助项目（200gA030201005）

摘　　要：目的探讨改良降落伞胰管空肠吻合法对胰十二指肠切除术后胰肠吻合口瘘发生率的影响。方法回顾性分析本院123例胰十二指肠切除术并使用了胰管空肠黏膜吻合方式患者的临床资料，其中61例间断式胰管空肠吻合和62例降落伞式胰管空肠吻合，观察并比较两组的术中、术后情况及术后并发症情况的差异。结果两组患者的胰腺质地、是否保留幽门、是否行胰管引流、术中失血量，手术耗时等手术参数差异均无统计学意义（P〉0．05）。两组患者术后出血率、胃排空障碍发生率、术后腹腔感染发生率差异均无统计学意义（P〉0．05）。两组患者胰瘘发生率差异无统计学意义（P〉0．05），但降落伞式胰管空肠吻合组术后B或C级胰瘘显著少于间断式胰管空肠吻合组（P〈0．05）。结论改良降落伞式胰管空肠吻合可降低胰十二指肠切除术术后胰瘘的严重程度。Objective To explore the effect of modified parachute-like pancreaticojejunostomy on incidence of pancreatic fistula after pancreatoduodeneetomy. Methods The clinical data of 123 patients undergoing pancreatoduodenectomy with application of duet-to-mucoca pancreaticojejunostomy were analyzed retrospectively. Interrupted suture technique and modified parachute suture technique were performed in 61 and 62 patients, respectively. Postoperative complications, data during and after pancreatoduodenectomy between two groups were compared. Results There were no significant differences in pancreatic texture, pylorus preservation, pancreatic duct drainage, intraoperative blood loss, and operating time between two groups （ P 〉 0. 05 ）. No significant differences between two groups were observed on postoperative morbidi- ty of gastrointestinal or intraabdominal hemorrhage, delayed gastric emptying, and intraabdominal abscess （P 〉 0. 05 ）. Although there was no significant difference in the incidence of postoperative pancreatic fistula （ P 〉 0. 05）, the grades B/C postoperative pancreatic fistula in modified parachute suture group was significantly less than in interrupted suture group （ P 〈 0. 05 ）. Conclusions Modified parachute-like pancreaticojejunostomy technique in pancreatoduodenectomy can reduce the incidence of severe postoperative pancreatic fistula.

关 键 词：胰管空肠吻合术/方法 胰十二指肠切除术/副作用 胰腺瘘/病因学/预防和控制 肠瘘/病因学/预防和控制 

分 类 号：R656[医药卫生—外科学]