胰肠吻合口大网膜包裹技术在胰十二指肠切除术中的应用效果及其对胰瘘的影响  

Effect of pancreatic-intestinal anastomosis with greater omentum wrapping in pancreaticoduodenectomy and its influence on pancreatic fistula

作　　者：杜刚[1] 靳福廷 袁涛 张泽奎[2] DU Guang;JIN Fu-ting;YUAN Tao;ZHANG Ze-kui(Second Division of Surgery Department,People＇s Hospital of Aba Tibetan and Qiang Autonomous Prefecture,Aba,Sichuan 624000,China)

机构地区：[1]阿坝藏族羌族自治州人民医院外二科,四川阿坝624000 [2]阿坝藏族羌族自治州人民医院ICU,四川阿坝624000

出　　处：《中国临床研究》2018年第7期918-921,共4页Chinese Journal of Clinical Research

摘　　要：目的探讨在胰十二指肠切除术中应用胰肠吻合口大网膜包裹技术的效果及其对胰瘘的影响。方法回顾性分析2012年1月至2017年1月收治的126例行胰十二指肠切除术患者的临床资料,根据手术方式不同分为试验组和对照组,试验组63例采用胰肠吻合口大网膜包裹技术,对照组63例常规采用胰肠吻合技术。统计患者手术时间、术中出血量、术前后肝功能、术后住院时间和胰瘘及其他并发症情况,并对影响胰瘘发生的危险因素进行Logistic单因素回归分析。结果两组患者在手术时间、术中出血上差异无统计学意义(P均>0.05),试验组患者住院时间短于对照组(P<0.05);组间比较,仅试验组术后72 h胆红素水平低于对照组(P<0.05),余术前、术后各时点两组患者胆红素、白蛋白水平差异均无统计学意义(P均>0.05);试验组胰瘘发生率(30.2%vs 54.0%,P<0.05)、其他并发症总发生率(50.8%vs 68.2%,P<0.05)均低于对照组;年龄大、患糖尿病、术前白蛋白水平低、胆红素水平高、胰腺炎病史、病理恶性和未行网膜包裹是影响胰十二指肠切除术后胰瘘发生的危险因素(P均<0.05)。结论胰肠吻合口大网膜包裹技术能有效改善胰十二指肠切除术患者的预后,低龄、无糖尿病、术前白蛋白和胆红素正常水平、无胰腺炎病史、病理良性、有网膜包裹等因素,有利于降低胰瘘等并发症的发生率。Objective To explore the application of pancreatic-intestinal anastomosis with greater omentum wrapping in pancreaticoduodenectomy（ PD） and its effect on pancreatic fistula. Methods The clinical data of 126 patients with scheduled pancreatoduodenectomy from January 2012 to January 2017 were analyzed retrospectively. According to different surgical methods,all patients were divided into the experimental group（ n = 63） in which greater omentum wrapping technique of the pancreatic intestinal anastomosis was performed and the control group（ n = 63） in which routine pancreaticoduodenal anastomosis technique was performed. The time of operation,the amount of intra-operation bleeding,the liver function detection before and after operation,the postoperative hospital stay,pancreatic fistula and the incidence of other complications were recorded,and the factors affecting the occurrence of pancreatic fistula were analyzed by multifactors analysis. Results There were no significant differences in operation time and intraoperative bleeding between two groups（ all P〈0. 05）,but the hospitalization time was significantly lower in experimental group than that in control group（ P〈0. 05）. The bilirubin level in experimental group was statistically lower than that in control group at postoperative 72 hours（ P〈0. 05）,however,there were no statistical differences in the levels of bilirubin and albumin at each time point before and after surgery（ all P〈0. 05）. The incidence of pancreatic fistula（ 30. 2% vs 54. 0%） and other complications（ 50. 8% vs 68. 2%） were lower in experimental group than those in control group（ all P〈0. 05）. Older,diabetes,low levels of preoperative albumin,hight levels of bilirubin,history of pancreatitis,pathological malignant and without greater omentum wrapping were the influencing factors of postoperative pancreatic fistula（ all P〈0. 05）. Conclusions The technique of pancreatic-intestinal anastomosis with greater omentum wrapping can effectively improve

关 键 词：胰肠吻合 大网膜包裹 胰十二指肠切除 胰瘘 

分 类 号：R656[医药卫生—外科学]