双层连续缝合法行胰腺空肠吻合在胰十二指肠切除术中的应用  

The application of double layer continuous suture in pancreatic-jejunum anastomosis underwent pancreatoduodenectomy

作　　者：纪伟平 邵卓[1] 宋彬[1] 马洪运[1] 胡先贵[1] 金钢[1] 毕建威[1] 

机构地区：[1]第二军医大学长海医院普外科,上海200433

出　　处：《中华胰腺病杂志》2016年第3期145-148,共4页Chinese Journal of Pancreatology

基　　金：长海医院“1255”学科建设项目（CH125542400）

摘　　要：目的：探讨胰十二指肠切除术中双层连续缝合法行胰腺空肠吻合的应用价值。方法回顾性分析2012年7月至2013年6月间上海长海医院收治的114例连续行胰十二指肠切除术患者的资料，其中有79例采用双层连续缝合法行胰空肠吻合，35例采用双层间断缝合法行胰空肠吻合，对比两种方法的的手术时间、术中失血量、术后进食时间、术后住院时间和术后胰瘘发生情况。结果双层连续缝合组和双层间断缝合组的手术时间分别为（284±5）、（288±7） min，术中出血量分别为（236±29）、（282±49）ml，两组间差异均无统计学意义。术后进食时间分别为（7．8±0．5）、（9．7±0．5）d，住院天数为（14．0±1．0）、（17．2±10．0）d，术后胰瘘发生率分别为17．1％（6／35）、39．2％（31／79），两组间差异均有统计学意义（ P值均＜0．05）。双层连续缝合组A级胰瘘4例（11．4％），B级胰瘘1例（2．9％）， C级胰瘘1例（2．9％）；双层间断缝合组分别为5例（6．3％）、23例（29．1％）、3例（3．8％）。两组术后30 d内均无死亡病例。结论双层连续缝合法可安全应用于胰空肠吻合，术后进食时间、住院天数、胰瘘发生率均显著低于双层间断缝合法，值得在临床推广应用。Objective To investigate the application value of double-layer continuous suture in pancreatic jejunum anastomosis of pancreatoduodenectomy （PD）.Methods A retrospective analysis of 114 consecutive patients （67 men and 47 women） who underwent PD from June 2012 to July 2013 were conducted. There were 79 patients who were treated by double-layer continuous suture technique and 35 patients by double-layer interrupted suture technique .The incidence of pancreatic fistula and other complications after PD with two different suture techniques were compared .Results The operation time of double-layer continuous suture group and double-layer interrupted suture group is respectively （ 284 ±5 ） and （ 288 ±7 ） mins, the intraoperative bleeding volume is respectively （236 ±29） and （282 ±49） ml, the differences between two groups were no statistical significance .The postoperative fasting time in two group was respectively （7.8 ± 0.5） and （9.7 ±0.5） days, the length of hospital stay time was respectively （14.0 ±1.0） and （17.2 ± 10.0） days, the incidence of postoperative pancreatic fistula （ POPF） was respectively 17.1%（6/35） and 39.2%（317/9 ）, the differences between two groups were statistically significant （all P＆lt;0.05）.Grade A POPF was found in 4 patients （ 11.4%） from the double-layer continuous suture group and in 5 patients （6.3%） from the double-layer interrupted suture group.Grade B POPF was identified only in 1 patients （2.9%） from the double-layer continuous suture group and in 23 patients （29.1%） from the double-layer interrupted suture group .The presence of Grade C POPF was only documented in 1 patient from the double-layer continuous suture group and in 3 patients from the interrupted suture group .Conclusions Continuous suture can be safely used in the duct-to-mucosa pancreatojejunostomy .The double-layer continuous suture can be more effective in reducing pancreatic fistula , improving the feeding time , and reducing the length o

关 键 词：胰十二指肠切除术 胰管空肠吻合术 缝合技术 

分 类 号：R656[医药卫生—外科学]