大网膜衬垫技术在胰十二指肠切除术中应用研究  

Application of omental-pad in reducing postoperative pancreatic fistula and associated severe complications after pancreaticoduodenectomy

作　　者：邓尧 姜翀弋[1] 梁赟 王宏伟[1] 蔡志伟 王巍[1] DENG Yao;JIANG Chong-yi;UANG Yun(Department of General Surgery,Huadong Hospital Affiliated to Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华东医院胆胰中心

出　　处：《中国实用外科杂志》2020年第2期218-223,共6页Chinese Journal of Practical Surgery

基　　金：上海市申康医院发展中心专科疾病临床“五新”转化项目（No.16CR3107B）

摘　　要：目的探讨大网膜衬垫技术在降低胰十二指肠切除术(PD)术后胰瘘及其相关并发症发生率的应用价值。方法回顾分析2015年1月至2018年12月复旦大学附属华东医院普外科实施的196例PD病人病例资料。根据是否采用网膜衬垫技术分为网膜衬垫组(127例,64.8%)和对照组(69例,35.2%),比较两组术后并发症情况。结果网膜衬垫组发生B/C级胰瘘13例(10.2%)、胆瘘2例(1.6%)、迟发性出血1例(0.8%)、再手术3例(2.4%),均低于对照组的17例(24.6%)、5例(7.2%)、8例(11.6%)、6例(8.7%),差异有统计学意义(P<0.05)。网膜衬垫组胆肠侧引流管拔除时间,胰肠侧引流管拔除时间,开放饮食时间,术后住院天数均短于对照组(P<0.05)。单因素分析提示,BMI、胰管宽度和大网膜衬垫技术与PD术后胰瘘的发生相关;多因素分析提示,BMI≥24、胰管<3 mm和未应用大网膜垫是PD术后胰瘘发生的独立危险因素(P<0.05)。结论网膜衬垫技术运用于PD能显著减少术后胰瘘及相关并发症,提高手术安全性。Objective To investigate the value of the omental-pad technique in reducing the incidence of pancreatic fistula and associated complications after pancreaticoduodenectomy(PD).MethodsThe clinical data of 196 consecutive patients who underwent PD performed in the Department of General Surgery at Huadong Hospital Affiliated to Fudan University between January 2015 and December 2018 were analyzed retrospectively.All the patients included a pedicled omental group(127,64.8%)and a control group(69,35.2%).Patient demographics,data of laboratory and complications were analyzed for interrelationships.Results Compared with the control group,the omental-pad group had lower B/C pancreatic fistula rate(13,10.2%),lower biliary fistula rate(2,1.6%),less postoperative delayed hemorrhage(1,0.8%),lower recoperation rate(3,2.4%),earlier time to remove bilateral drainage tubes,earlier time to restore a liquid diet,and shorter postoperative hospital stay(P<0.05).According to the result of univariate factor analysis,BMI,pancreatic duct diameter and omental-pad were related to the postoperative pancreatic fistula.BMI≥24,pancreatic duct diameter<3mm and non-application of the omental-pad were independent risk factors for pancreatic fistula in the multivariate factors analysis(P<0.05).ConclusionThe omental-pad technique is an effective and safe method to reduce pancreatic fistula and associated complications after PD.

关 键 词：大网膜衬垫 胰十二指肠切除术 胰瘘 

分 类 号：R6[医药卫生—外科学]