荷包套入式胰肠端侧吻合法对术后胰痿发生率的影响——单中心581例临床经验总结  

The effect of end-to-side pancreaticojejunostomy with pocket insertion on the incidence of pancreatic fistulaafter operation

作　　者：柴伟[1] 雷豹[1] 孟宇[1] 赵秀雷[1] 张雷[1] 孔德帅[1] 刘汝海[1] Chai Wei;Lei Bao;Meng Yu;Zhao Xiulei;Zhang Lei;Kong Deshuai;Liu Ruhai(Department of General Surgery,Cangzhou Central Hospital of Hebei Province,Cangzhou 061000,China)

机构地区：[1]河北省沧州市中心医院普通外科,061000

出　　处：《中华内分泌外科杂志》2019年第6期492-496,共5页Chinese Journal of Endocrine Surgery

摘　　要：目的探讨荷包套入式胰肠端侧吻合法对胰十二指肠切除术后胰痿发生率的影响。方法回顾性分析2012年12月至2018年9月沧州市中心医院普外科581例施行胰十二指肠切除手术患者的临床资料,其中包括开放胰十二指肠切除术(open pancreaticoduodenectomy,OPD)327例、腹腔镜辅助胰十二指肠切除术(laparoscopic assisted pancreaticoduodenectomy,LAPD)175例、全腹腔镜胰十二指肠切除术(total laparoscopic pancreaticoduodenectomy,TLPD)79例,胰肠吻合均采用荷包套入式端侧吻合。统计分析各组及总体术后胰痿发生率情况。结果采用荷包套入式胰肠端侧吻合法术后总体B或C级胰痿发生率为3.10%(18/581)o0PD组术后B或C级胰痿发生率为2.75%(9/327),LAPD组术后B或C级胰痿发生率为2.29%(4/175),TLPD组术后B或C级胰痿发生率为6.33%(5/79)03组分别按胰腺质地各自分为a、b两个亚组,亚组间比较胰管直径差异具有统计学意义(PV0.05),但胰肠吻合时间及术后胰痿发生率比较差异均无统计学意义(P>0.05)o结论荷包套入式胰肠端侧吻合法具有操作简单、适应性强、安全高效等特点,并可将胰十二指肠切除术后胰痿发生率控制在理想水平。Objective To investigate the effect of end-to-side pancreaticojejunostomy with pocket-insertion on the incidence of pancreatic fistula after pancreaticoduodenectomy.Methods The clinical data of 581 patients undergoing pancreaticoduodenectomy from Dec.2012 to Sep.2018 in Cangzhou Central Hospital were retrospectively analyzed,including 327 cases of open pancreaticoduodenectomy(OPD),175 cases of laparoscopic assisted pancreaticoduodenectomy(LAPD),and 79 cases of total laparoscopic pancreaticoduodenectomy.End-toside pancreaticojejunostomy with pocket-insertion was used in all cases.The incidence of pancreatic fistula after operation was analyzed.Results The overall incidence of grade B or C pancreatic fistula was 3.10%(18/581)after end-to-side pancreaticojejunostomy with purse-pocket insertion.The incidence of grade B or C pancreatic fistula in OPD group was 2.75%(9/327).The incidence of grade B or C pancreatic fistula in LAPD group was 2.29%(4/175).The incidence of grade B or C pancreatic fistula in TLPD group was 6.33%(5/79).The three groups were divided into two subgroups according to the pancreatic texture.There was significant difference in pancreatic duct diameter between subgroups(P<0.05),but there was no significant difference in the time of pancreaticojejunostomy and the incidence of pancreatic fistula after operation(P>05).Conclusion End-to-side pancreaticojejunostomy with pocket insertion has the advantages of simple operation,strong adaptability,safety and high efficiency,and can control the incidence of pancreatic fistula after pancreaticoduodenectomy at an ideal level.

关 键 词：胰十二指肠切除术 胰肠吻合 胰腺痿 

分 类 号：R656[医药卫生—外科学]