改良胰管空肠黏膜端侧吻合胰十二指肠切除术临床效果研究  

Clinical application of modified end-to-side anastomosis of pancreatic duct and jejunal mucosa in PD

作　　者：罗耀兵 徐小立 Luo Yaobing;Xu Xiaoli(Emergency surgery Department,famous Hospital of Enshi Tujia and Miao Autonomous Prefecture,Hubei Province,Enshi 445000,Hubei;First Aid Center of famous nationality Hospital of Enshi Tujia and Miao Autonomous prefectures,Hubei Province,Enshi 445000,Hubei)

机构地区：[1]湖北省恩施土家族苗族自治州名族医院急诊外科,湖北恩施445000 [2]湖北省恩施土家族苗族自治州名族医院120急救中心,湖北恩施445000

出　　处：《中华普外科手术学杂志（电子版）》2020年第3期264-267,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：湖北省卫生和计划委员会基金项目(WJ2017H551)。

摘　　要：目的探讨改良胰管空肠黏膜端侧吻合的胰十二指肠切除术临床效果。方法回顾性分析2016年1月至2019年3月62例行胰十二指肠切除术(PD)患者临床资料,其中30例行改良胰管空肠黏膜端侧吻合术(改良组),32例行传统胰管空肠黏膜端侧吻合术(传统组)。选用SPSS 20.00统计学软件进行数据分析,围术期相关指标和术后第1、3、5、7、9 d的腹腔引流液淀粉酶水平用(±s)表示,采用独立t检验;并发症发生率采用χ^2检验,P<0.05差异有统计学意义。结果改良组出血量明显小于传统组(P<0.05),其余相关围术期指标差异均无统计学意义(P>0.05);改良组术后发生1例胰瘘明显小于传统组9例(P<0.05),其中改良组B级胰瘘发生率明显小于传统组(P<0.05),生化瘘、C级胰瘘发生率、淋巴瘘、胃排空发生率比较差异均无统计学意义(P>0.05);两组患者腹腔引流液淀粉酶含量在术后第1、3、5、7、9 d的检测期间内,传统组腹腔引流液淀粉酶含量小于改良组(P<0.05)。结论改良胰管空肠黏膜端侧吻合术相比于传统胰管空肠黏膜端侧吻合术在PD中能有效降低胰瘘的发生率,具有一定的临床推广价值。Objective To investigate the effect of modified end-to-side anastomosis of pancreatic duct and jejunal mucosa in pancreatoduodenectomy.Methods 62 patients with pancreaticoduodenectomy(PD)from January 2016 to March 2019 were retrospectively analyzed,which included 30 patients with modified end-to-side anastomosis of pancreatic duct and jejunal mucosa(modified group)and 32 cases of traditional end-to-side anastomosis of pancreatic duct and jejunal mucosa(traditional group).SPSS 20.00 statistical software was used for analysis.The postoperative complications of the two groups,the postoperative complications of pancreatic fistula,and the level of amylase in the abdominal drainage fluid at 1,3,5,7 and 9 days after operation were observed.The complication and other count data were expressed in n%,and compared with Fisher exact probability method orχ^2 test,perioperative indicators were expressed as(±s),and compared with t test.P<0.05 was a statistical difference.Results The amount of bleeding in the modified group was significantly lower than that in the traditional group(P<0.05).There were no significant differences in the other surgical indexes(P>0.05).In the modified group,1 case of pancreatic fistula was significantly smaller than 9 cases in the traditional group(P<0.05).The incidence of grade B pancreatic fistula in the modified group was significantly lower than that in the traditional group(P<0.05),and the difference of incidence of biochemical fistula and C-class pancreatic fistula between the two groups was not statistically significant(P>0.05).The contents of amylase in the abdominal drainage fluid of the two groups of patients was less than those in the modified group during the 1,3,5,7,9 d postoperative detection period.Conclusion Compared with the end-to-side anastomosis of pancreatic duct and jejunal mucosa,the modified end-to-side anastomosis of pancreatic duct and jejunal mucosa can effectively reduce the incidence of pancreatic fistula in PD,and has certain clinical promotion value.

关 键 词：胰十二指肠切除术 胰管空肠吻合术 胰腺瘘 引流术 胰腺α淀粉酶 

分 类 号：R73[医药卫生—肿瘤]