改良胰肠吻合方式在腹腔镜胰十二指肠切除术中的应用  

Application of modified pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy

作　　者：朱超[1] 金浩[1] 刘会春[1] 周磊[1] 王勇[1] 庞青 ZHU Chao;JIN Hao;LIU Hui-chun(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233000,China)

机构地区：[1]蚌埠医学院第一附属医院肝胆外科,安徽蚌埠233000

出　　处：《腹腔镜外科杂志》2020年第9期651-655,共5页Journal of Laparoscopic Surgery

基　　金：国家自然科学基金(81600452);蚌埠医学院第一附属医院高新技术项目(2020133);蚌埠医学院研究生科研创新计划(Byycxz1924)。

摘　　要：目的:探讨改良胰肠吻合方式在腹腔镜胰十二指肠切除术中的应用价值。方法:回顾分析2016年1月至2020年4月为77例患者行腹腔镜胰十二指肠切除术的临床资料,对比改良胰肠吻合方式(改良组)与胰管对空肠黏膜吻合方式(传统组)的临床指标。结果:两组患者临床资料及术中出血量、主胰管宽度、胰腺质地、术后病理差异无统计学意义(P>0.05)。改良组术后胰瘘发生率为5.4%,传统组为22.5%,差异有统计学意义(P<0.05)。改良组胰肠吻合时间、手术时间及术后住院时间短于传统组(P<0.05);两组术后胆漏、胃瘫、出血事件发生率差异无统计学意义(P>0.05)。结论:与胰管对空肠黏膜吻合方式相比,改良胰肠吻合方式可降低术后胰瘘发生率,缩短胰肠吻合时间、手术时间及术后住院时间,值得临床应用推广。Objective:To evaluate the clinical value of improved pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy.Methods:Retrospective analysis was performed on the case data of 77 patients who underwent laparoscopic pancreaticoduodenectomy from Jan.2016 to Apr.2020.Clinical indicators related to improved pancreaticojejunostomy(improved group)and pancreatic duct jejunal mucosal anastomosis(traditional group)were compared.Results:There was no significant difference in baseline data,intraoperative blood loss,width of the main pancreatic duct,pancreatic texture and postoperative pathology between the two groups(P>0.05).The incidence of pancreatic fistula was 5.4%in the modified group and 22.5%in the traditional group,the difference was statistically significant(P<0.05).The time of pancreaticojejunostomy,operative time and postoperative hospitalization time in the modified group were shorter than those in the traditional group(P<0.05).There was no significant difference in the incidence of postoperative biliary leakage,gastroparesis and bleeding events between the two groups(P>0.05).Conclusions:Compared with pancreatic duct anastomosis to jejunal mucosa,modified pancreaticojejunostomy can reduce the incidence of postoperative pancreatic fistula,shorten the time of pancreaticojejunostomy,operation time and postoperative hospitalization time,is worthy of further clinical application and promotion.

关 键 词：胰十二指肠切除术 腹腔镜检查 胰管空肠吻合术 胰瘘 

分 类 号：R657.5[医药卫生—外科学]