分离式环形连续缝合行胰肠黏膜吻合在胰十二指肠切除术中的临床研究  

Clinical study of pancreaticoenterostomy by separating and continuous suture in pancreatoduodenectomy

作　　者：王刚成[1] 韩广森[1] 刘英俊[1] 程勇[1] 任莹坤[1] 卢先枝[1] 黄平[2] 

机构地区：[1]郑州大学附属肿瘤医院河南省肿瘤医院普外科,郑州450008 [2]南京医科大学第一附属医院普外科

出　　处：《中华胰腺病杂志》2016年第1期19-22,共4页Chinese Journal of Pancreatology

摘　　要：目的探讨分离式环形连续缝合行胰肠黏膜吻合在胰十二指肠切除术中的临床应用效果。方法回顾性分析2002年3月至2014年10月郑州大学附属肿瘤医院收治的76例行根治性胰十二指肠切除术患者的临床资料。43例采用分离式环形连续缝合行胰肠黏膜吻合者作为研究组，33例采用端端套入捆绑式胰肠吻合方式者作为对照组。均采用Child消化道重建方式，术后胰瘘的诊断参照国际胰瘘研究小组（ISGPF）的诊断与分级标准。分析两组患者术中吻合操作时间，胰肠吻合术后吻合口漏、吻合口出血等情况。结果两组患者年龄，性别及血红蛋白、血清白蛋白、总胆红素等实验室指标，并发糖尿病例数，手术切除范围差异均无统计学意义，具有可比性。研究组43例患者的术中胰肠吻合时间平均为11min（8—15min），术后出现I级胰肠吻合口漏4例，Ⅱ级胰肠吻合口漏1例，未发生Ⅲ级胰肠吻合口漏及胰肠吻合口出血病例。对照组有记录的5例患者的胰肠吻合时间平均为16min（12—25min），其余病例无记录，术后出现Ⅰ级胰肠吻合口漏例数不详，Ⅱ级胰肠吻合口漏4例，Ⅲ级胰肠吻合口漏2例，胰肠吻合口出血4例。结论分离式环形连续缝合行胰肠黏膜对接吻合手术的视野暴露充分、吻合时间短、术后胰肠吻合口漏及吻合口出血发生率低。Objective To investigate the effects of pancreaticoenterostomy by separating and continuous suture on pancreatoduodenectomy. Methods The clinical data of 76 patients who underwent curative pancreaticoduodenectomy from March 2002 to October 2014 in Tumor Hospital of Zhengzhou University were retrospectively analyzed. Of all the patients, 43 received pancreaticoenterostomy by separating and continuous suture （study group）, and the other 33 patients received BPJ anastomosis （control group）. All the patients used Child reconstruction, the diagnosis of pancreatic fistula was made according to ISGPF criteria. The operation time of pancreaticoenterostomy, the incidence of hemorrhage of anastomosis and the incidence of pancreatic fistula were retrospectively analyzed. Results The age, sex, hemoglobin, albumin, total bilirubin, the incidence of co-morbidity of diabetes, extent of surgical resection between 2 groups were comparable without significant difference. In study group, the time of pancreaticoenterostomy was 11 min（ 8 - 15 min）, there were 4 patients with class Ⅰ pancreatic fistula, and 1 patient with class Ⅱ pancreatic fistula. No patient developed class Ⅲ pancreatic fistula or anastomotic bleeding. In control group, the time of pancreaticoenterostomy was 16 min（ 12- 25 rain） which was only available for 5 patients, and no records for other patients. There were 6 patients with pancreatic fistula including 4 patients with class Ⅱ, 2 patients with class Ⅲ, while no records for class I. Four patients were found to have anastomotic bleeding. Conclusions With the pancreaticoenter^stomy hy separating and conlinuous suture method, the surgical field is fully exposed, the suture time is shmlened and the incidence of anastomotic hleeding and ancreatic fistula is reduced.

关 键 词：胰十二指肠切除术 胰管空肠吻合术 缝合技术 出血 胰漏 

分 类 号：R657.5[医药卫生—外科学]