胰肠双吻合预防胰腺中段切除术后胰痿发生的初步研究  

Preliminary study of double pancreaticojejunostomy for prevention of pancreatic flstulas after centralpancreatectomy

作　　者：孟兴凯[1] 王慧君 田全发 郑卫华 张俊晶[1] Meng Xingkai;Wang Huijun;Tian Quanfa;Zheng Weihua;Zhang Jurying(Department of Hepatobiliary Surgery,the Affiliated Hospital of Inner Mongolia Medical University,Huhhot 010050,China)

机构地区：[1]内蒙古医科大学附属医院肝胆外科,呼和浩特010050

出　　处：《中华内分泌外科杂志》2019年第6期488-491,共4页Chinese Journal of Endocrine Surgery

基　　金：内蒙古自治区草原英才培养专项基金(CYYC2012040);内蒙古自治区卫生计生科研项目(201702087).

摘　　要：目的探讨胰肠双吻合技术在预防胰腺中段切除术后胰痿发生的价值。方法回顾性分析2012年2月至2018年12月在内蒙古医科大学附属医院住院治疗的10例患者临床资料。结果10例患者均实施胰腺中段切除,近侧残端缝闭、胰肠套入式吻合术;同时,远侧残端行胰肠套入式或胰管对黏膜吻合,既改良胰肠双吻合技术。手术时间为(240±60)min,术中平均出血量300 mlo胰痿发生率30%(3/10),为A级痿;没有B级、C级胰痿;无围手术期死亡。术后住院时间9~25(15.4±8.3)do术后随访,患者的内外分泌功能保留良好,与术前一致,无肿瘤复发。结论尽管采用胰肠双吻合技术增加手术时间和难度,但初步研究发现,该技术能降低胰痿的发生率,且安全可行。Objective To evaluate the significance of double pancreatico-jejunostomy in preventing pancreatic fistula after central pancreatectomy(CP).Methods The clinical data of 10 patients who were admitted to the Affiliated Hospital of Inner Mongolia Medical University from Feb.2012 to Dec.2018 were analyzed retrospectively.Results All the 10 patients underwent CP,closure of the proximal pancreatic stump,and end-to-side invaginated pancreaticojejunostomy;At the same time,invaginated pancreaticojejunal anastomosis or duct-to-mucosa pancreaticojejunostomy was performed to the distal pancreatic remnant.The duration of the operation was(240±60)min,and the average intraoperative blood loss was 300 ml.Incidence of pancreatic fistulas was 30%(3/10).There were no grade B or C pancreatic fistulas,or perioperative deaths.The duration of postoperative hospital stay varied from 9 to 25 days.Endocrine and exocrine functions were well maintained during the followups of 7 months to 5 years,and no tumors recurred.Conclusions Although operation time and technical difficulty increase,central pancreatectomy using double pancreaticojejunostomy is safe,feasible,and appears to be as・sociated with a low rate of postoperative pancreatic fistulas.

关 键 词：胰腺空肠套入式吻合 胰腺中段切除术 胰颈体肿瘤 胰痿 

分 类 号：R657.5[医药卫生—外科学]