两种捆绑式吻合术对胰十二指肠切除术患者疗效及术后胰瘘的影响  

Effect of two kinds of binding anastomosis on patients with pancreaticoduodenectomy and postoperative pancreatic fistula

作　　者：胡雅静 闵焕娣 宋烨[2] 李甜 HU Ya-jing;MIN Huan-di;SONG Ye;LI Tian(Department of General Surgery,East Hospital of First Affiliated Hospital of Xi′an Jiaotong University,Xi′an Shaanxi 710089,China;Emergency Department,First Affiliated Hospital of Xi′an Jiaotong University,Xi′an Shaanxi 710089,China)

机构地区：[1]西安交通大学第一附属医院东院普外科,陕西西安710089 [2]西安交通大学第一附属医院急诊科,陕西西安710089

出　　处：《局解手术学杂志》2020年第5期393-396,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：陕西省自然科学基础研究计划项目(2017JD1223)。

摘　　要：目的探讨两种捆绑式吻合术对胰十二指肠切除术(PD)患者疗效及术后胰瘘的影响。方法回顾性分析2016年1月至2018年12月西安交通大学第一附属医院收治的140例PD患者的临床资料,按照手术方式的不同分为BPG组(行捆绑式胰胃吻合手术)74例和BPJ组(行捆绑式胰肠吻合手术)66例。比较2组患者围手术期指标(手术时间、术中出血量、吻合时间、住院时间),评估术前、术后10 d胰腺功能(血清淀粉酶、脂肪酶、糖化血红蛋白)、胃功能(胃泌素、胃动素),记录2组患者术后并发症发生率。结果BPG组吻合时间短于BPJ组,差异有统计学意义(P<0.05);2组患者手术时间、术中出血量、住院时间比较,差异无统计学意义(P>0.05);术后10 d,2组患者血清淀粉酶、脂肪酶、胃泌素、胃动素水平均低于术前,差异有统计学意义(P<0.05),但组间比较差异无统计学意义(P>0.05);术后10 d,2组患者糖化血红蛋白与术前比较,差异均无统计学意义(P>0.05),组间比较差异无统计学意义(P>0.05);患者胰瘘、胃排空障碍、术后出血、切口感染等并发症发生率组间比较,差异均无统计学意义(P>0.05)。结论BPG与BPJ均可应用于PD患者,但BPG术式吻合时间更短,操作难度更小。Objective To explore the efficacy of two kinds of binding anastomosis on patients with pancreaticoduodenectomy(PD)and the effects on postoperative pancreatic fistula.Methods The clinical data of 140 patients treated with PD in the first affiliated hospital of Xi′an Jiaotong university from January 2016 to December 2018 were retrospectively analyzed.According to the different surgical methods,the patients were divided into BPG group(74 cases treated by binding pancreaticogastrostomy)and BPJ group(66 cases treated by binding pancreaticojejunostomy).Perioperative indexes(operative time,intraoperative blood loss,anastomosis time,hospital stay)were compared between the two groups.Pancreatic function(serum amylase,lipase,glycosylated hemoglobin)and gastric function(gastrin,motilin)were evaluated before operation and at 10 days after operation.The incidence rate of postoperative complications were recorded in the two groups.Results The anastomosis time in BPG group was shorter than that in BPJ group,the difference was significant(P<0.05).There was no significant difference in the operative time,intraoperative blood loss and hospital stay between the two groups(P>0.05).At 10 days after operation,the levels of serum amylase,lipase,gastrin and motilin in the two groups were both lower than those before operation,with significant differences(P<0.05),but there was no significant difference between the two groups(P>0.05).At 10 days after operation,there was no significant difference in glycosylated hemoglobin of the two groups compared with that before operation(P>0.05),and there was no significant difference between the two groups(P>0.05).There was no significant difference in the incidence rate of complications such as pancreatic fistula,delayed gastric emptying,postoperative bleeding and incision infection between the two groups(P>0.05).ConclusionBoth BPG and BPJ can be used for patients with PD,and the former one has a shorter anastomosis time and less operative difficulty.

关 键 词：胰十二指肠切除术 胰胃吻合 胰肠吻合 

分 类 号：R657.5[医药卫生—外科学]