胰肠吻合方式与胰瘘(附477例报告)  

Incidence of Pancreatic Leak age in Pancreaticojej unostomy following Pancreaticoduodenectomy: A Report of 47 7 Cases.

作　　者：胡志浩[1] 胡先贵[1] 刘瑞[1] 张怡杰[1] 唐岩[1] 王本茂[1] 

机构地区：[1]第二军医大学附属长海医院普外科,200433

出　　处：《外科理论与实践》2002年第5期346-348,共3页Journal of Surgery Concepts & Practice

摘　　要：目的 :本文探讨胰十二指肠切除术胰肠吻合方式与胰瘘预防的关系。方法 :回顾 1 988年 1月至 2 0 0 2年 4月477例胰十二指肠切除术病例 ,胰肠吻合方式包括端端套入吻合、端侧套入吻合、胰管空肠端侧黏膜吻合 ;胰管支撑和胰液引流包括胰管支撑内引流、胰管支撑外引流和无胰管支撑等。结果 :术后胰瘘总发生率为 2 .52 % (1 2 477) ,96年前为 6 .78% (8 1 1 8) ,死亡 2例 ;1 996年后为 1 .1 1 % (4 359) ,死亡 1例。同时期吻合方式比较 ,1 996年前的两种主要吻合方式中 ,胰管空肠端侧黏膜吻合法的胰瘘发生率显著低于端端套入法 (χ2 =4.30 34 ,P <0 .0 5)。1 996年后的两种主要吻合方式中 ,胰管空肠端侧黏膜吻合法的胰瘘发生率显著低于端侧套入吻合法 (χ2 =1 3 .5778,P<0 .0 1 )。端端套入吻合法放置胰管外引流的胰瘘发生率显著低于单纯内支撑 (χ2 =4.82 4 4 ,P <0 .0 5) ;胰管空肠端侧黏膜吻合法放置胰管外引流与单纯内引流相比相差不显著 (χ2 =0 .2 842 ,P >0 .0 5)。结论 :操作技术的熟练程度是影响胰瘘发生率的重要因素。胰管空肠端侧黏膜吻合法优于端侧套入和端侧套入吻合法。在吻合技术不熟练时 。To evaluate the possib le difference in the incid ence of pancreatic leakage relative to various methods of pancreatico-jejunal r econstruction. Methods: Four hundred a nd seventy-seven cases o f pancreaticoduodenectomy performed were reviewed. The types of pancreaticojejun ostomy included pancreatico-jejunal end-to-end anastom osis, end-to-side an astomosis and end-to-side 'mucosa-to-mucosa' anastomosis , with external or i nternal transanastomo- tic drainage. Results: The overall inc idence of pancreatic fistula was 2.52%, being 6.78% and 1.11% before and after t he year 1996. The leakage rate following end-to-side 'mucos a -to-mucosa' anas tomosis was significantly lower than those of end-to-end anast o mosis(χ 2 = 4.3034, P<0.05), and those of end-to-side anas tomosis(χ 2 =13.5778,P<0.01). End-to-end anastomosis with external tran sanastomotic drainage was better than those with internal transana stomotic drain age(χ 2 = 4.8244, P<0.05),but there was no s ignificant diff erence between end-to-side 'mucosa-to-mucosa' anastomosis with external or i nternal transanastomotic drainage(χ 2 = 0.2842, P>0.05). Conclusions: The surgeon's experience seems to be an important f actor. End-to-side 'mucosa-to-mucosa' anastomosis has the lowe st morbidity r ate. External transanastomotic drainage is helpful when the surgica l performance is deemed unsatisfactory.

关 键 词：胰头十二指肠切除术 胰腺-空肠吻合术 胰瘘 预防 

分 类 号：R657.5[医药卫生—外科学]