改良胃管引流对胰十二指肠切除术后胰瘘的影响及机制分析  

Effect of modified gastric tube drainage on pancreatic fistula after pancreatoduodenectomy and its mechanism analysis

作　　者：丁科 朱浩[1] 伍承天 王振乾[1] 黄河[1] Ding Ke;Zhu Hao;Wu Chengtian;Wang Zhenqian;Huang He(Department of General Surgery, the 85th Hospital of People's Liberation Army, Shanghai 200052, China)

机构地区：[1]中国人民解放军第八五医院普外科,上海200052

出　　处：《中华普通外科学文献（电子版）》2019年第2期130-133,共4页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的分析胰十二指肠切除术(PD)中改进胃管引流对于预防术后胰瘘的临床效果及可能机制,为临床患者治疗提供一些借鉴。方法回顾性分析2012年12月至2017年12月间中国人民解放军第八五医院行PD治疗的患者200例,依据患者手术中胃管不同处理方式将其分成观察组(86例,胃肠吻合口输入襻15 cm位置将14 Fr胃管放入胰肠吻合口输入襻中)与对照组(114例,胃内放入规格14 Fr一次性胃管),比较患者手术时间、胰管直径、胰腺质地、术中出血量、胃管拔除时间、腹腔引流管拔除时间及下床活动时间等,患者胰瘘发生率及术后第3天胃管引流量和淀粉酶含量状况,观察胰瘘患者和无胰瘘患者术后第3天胰周及胃管引流量、淀粉酶水平。结果观察组患者术后腹腔引流管拔除时间、胰瘘发生率显著低于对照组,差异有统计学意义(t=5.029,P<0.05;8.14%vs 29.82%,χ~2=13.276,P<0.05)。两组发生胰瘘及无胰瘘患者的术后第3天胰周引流量及引流液淀粉酶水平、胃管引流量及引流液淀粉酶水平差异均有统计学意义(F=16.373、31.064、19.882、64.291,均P<0.05)。观察组无胰瘘患者的术后第3天胰周引流量、胰周引流淀粉酶、胃管引流液淀粉酶水平均显著低于对照组,胃管引流量则显著升高,差异均有统计学意义(t=6.371、12.054、10.371、32.064,均P<0.05)。结论改良胃管引流术可显著降低PD患者术后胰瘘发生率,及时监测患者胃管引流量和淀粉酶水平对前期诊断胰瘘有指导意义。Objective To analyze the clinical effect and possible mechanism of preventing pancreatic fistula after pancreatoduodenectomy (PD), and to provide clinical reference for patients. Methods A retrospective analysis was performed in two hundred patients undergoing PD treatment in the 85th Hospital of the People's Liberation Army from December 2012 to December 2017. According to the different treatment methods of gastric tube during the operation, the patients were divided into observation group (86 cases, at the 15 cm position of the input loop of the gastrointestinal anastomosis, 14 Fr gastric tube was put into the loop of pancreaticointestinal anastomosis), and the control group (114 cases, 14 Fr disposable gastric tube was placed in the stomach). The operation time, diameter of the pancreatic duct, quality of the pancreas, the amount of intraoperative bleeding, extraction time of drainage tube, ambulation time, the incidence of pancreatic fistula, the flow of tube and the content of amylase 3 days after the operation were observed and compared. Results The removal time of abdominal drainage tube, rate of pancreatic fistula in the observation group were lower than those of the control group, the differences were statistically significant (t=5.029, P<0.05;8.14% vs 29.82%,χ^2=13.276, P<0.05). The differences of amylase level, flow rate of drainage fluid were statistically significant among pancreatic fistula and no-fistula subgroups (F=16.373, 31.064, 19.882, 64.291, all P<0.05). Compared to the control group, there was significant decrease in the peripancreatic drainage volume, peripancreatic amylase level in drainage 3 days after operation in the observation group, while the flow rate of gastric tube increased significantly, the differences were statistically significant (t=6.371, 12.054, 10.371, 32.064, all P<0.05). Conclusions Modified gastric tube drainage can significantly reduce the incidence of postoperative pancreatic fistula in patients with PD. Timely monitoring of gastric tube drainage and amylase level

关 键 词：胰十二指肠切除术 引流术 胃管 胰腺瘘 

分 类 号：R656[医药卫生—外科学]