胰管-空肠黏膜对黏膜间断式吻合在腹腔镜胰十二指肠切除术中的应用  

Application of discontinuous anastomosis of pancreatic duct jejunum mucosa to mucosa in laparoscopic pancreaticoduodenectomy

作　　者：张成[1] 安琳 王羊 安东均 杨林[1] 王金涛[1] 韩立 赵宝国 徐垚 ZHANG Cheng;AN Lin;WANG Yang;AN Dong-jun;YANG Lin;WANG Jin-tao;HAN Li;ZHAO Bao-guo;Xu Yao(Department of Hepatobiliary Surgery,Xianyang Central Hospital,Xi'an Jiaotong University,Shanxi 712000,China;School of Statistics,Xi'an University of Finance and Economics,Xi'an 710100,China)

机构地区：[1]西安交通大学附属咸阳市中心医院肝胆外科,陕西咸阳712000 [2]西安财经大学统计学院,陕西西安710100

出　　处：《肝胆胰外科杂志》2020年第10期600-604,共5页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨腹腔镜胰十二指肠切除术中应用胰管-空肠黏膜对黏膜间断式吻合预防和减少胰瘘的临床效果。方法回顾性分析2016年3月至2019年6月西安交通大学附属咸阳市中心医院收治的86例行胰十二指肠切除术患者的临床资料,根据不同胰肠吻合方式分为传统吻合组(传统组,45例)和改良胰管-空肠黏膜对黏膜间断式吻合组(改良组,41例)。观察比较两组手术时间、胰肠吻合时间、术中出血量、术后胰瘘发生率和其他并发症、术后住院时间等围手术期指标的差异。结果两组患者无围手术期死亡,均成功完成预定Whipple手术,全部采用Child消化道重建。术中情况:传统组与改良组术中出血量分别为(410±220)mL、(365±150)mL(t=0.321,P=0.060),胆肠吻合时间分别为(22±9)min、(23±11)min(t=0.838,P=0.563),胃肠吻合时间分别为(23±8)min、(22±9)min(t=0.726,P=0.212),上述指标两组比较无统计学差异;术中胰肠吻合时间分别为(25±10)min、(41±12)min(t=2.512,P=0.032);总手术时间分别为(240±20)min、(315±25)min(t=5.362,P=0.048),两组比较有统计学差异,改良组多于传统组。术后情况:传统组A级胰瘘5例、B级胰瘘8例,改良组A级胰瘘1例、B级胰瘘2例(χ^2=3.216,P=0.019);术后住院时间分别为(15.2±3.2)d、(10.3±1.1)d(t=-1.526,P=0.016),两组比较有统计学差异,改良组优于传统组。结论应用改良胰管-空肠黏膜对黏膜间断式吻合,相较于传统的胰肠套入式吻合可以降低胰十二指肠切除术后胰瘘发生率,缩短住院时间,从而改善临床疗效。Objective To investigate the clinical efficacy of discontinuous anastomosis of pancreatic duct jejunum mucosa to mucosa in laparoscopic pancreaticoduodenectomy(LPD).Methods The clinical data of 86 patients received LPD in Xianyang Central Hospital from Mar.2016 to Jun.2019 were retrospectively analyzed.Patients were divided into traditional anastomosis group(traditional group,45 cases)and modified discontinuous anastomosis group(modified group,41 cases).The differences of operation time,pancreaticojejunostomy time,intraoperative blood loss,postoperative pancreatic fistula incidence,postoperative hospitalization time and other perioperative indicators were compared between the two groups.Results There was no perioperative death in the two groups,all successfully completed the scheduled Whipple surgery,and performed with Child gastrointestinal reconstruction.Intraoperative conditions:for the traditional group and modified group,intraoperative blood loss was(410±220)mL and(365±150)mL(t=0.321,P=0.060),the time of bile duct anastomosis was(22±9)min and(23±11)min(t=0.838,P=0.563),time of gastrointestinal anastomosis was(23±8)min and(22±9)min(t=0.726,P=0.212),respectively,there was no statistically significant difference between two groups.The time of intraoperative pancreaticojejunostomy was(25±10)min and(41±12)min(t=2.512,P=0.033),total operation time was(240±20)min and(315±25)min(t=5.362,P=0.048),the differences between two groups were statistically significant.Postoperative conditions:for pancreatic fistula,5 cases of grade A and 8 cases of grade B were found in traditional group,1 case of grade A and 2 cases of grade B were found in modified group(χ^2=3.216,P=0.019);for postoperative hospitalization time,(15.2±3.2)d in traditional group and(10.3±1.1)d in modified group(t=-1.526,P=0.016),the differences between two groups were statistically significant.Conclusion For patients undergoing LPD,the application of modified discontinuous anastomosis of pancreatic duct jejunum mucosa to mucosa can reduce the i

关 键 词：胰十二指肠切除术 WHIPPLE手术 胰肠吻合方式 改良胰管-空肠黏膜对黏膜间断式吻合 消化道重建 

分 类 号：R657.5[医药卫生—外科学] R656.6[医药卫生—临床医学]