“Double R”胰管空肠吻合方式在腹腔镜胰十二指肠切除术中的应用  

Clinical application of“Double R”pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy

作　　者：邱建国 唐伟[1] 李明[1] 史政荣[1] 魏续福[1] 肖衡[1] 杜成友[1] QIU Jianguo;TANG Wei;LI Ming;SHI Zhengrong;WEI Xufu;XIAO Heng;DU Chengyou(Department of Hepatobiliary Surgery,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,P.R.China)

机构地区：[1]重庆医科大学附属第一医院肝胆外科,重庆400016

出　　处：《中国普外基础与临床杂志》2020年第10期1216-1220,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：重庆市科委基础研究与前沿探索项目(项目编号:cstc2018jcyjAX0825)。

摘　　要：目的探讨“Double R”胰管空肠吻合在腹腔镜胰十二指肠切除(PD)术中的临床应用效果。方法回顾性收集2018年11月至2019年12月期间重庆医科大学附属第一医院肝胆外科在腹腔镜PD术中应用“Double R”完成胰管空肠导管对黏膜吻合治疗的20例患者的临床病理资料,分析胰肠吻合时间、术后胰瘘发生率及其他并发症发生率、死亡率、住院时间等临床指标。结果20例患者中男11例,女9例;年龄(56±10)岁,体质量指数(22.6±4.4)kg/m^2。20例患者均顺利完成腹腔镜PD手术,无中转开腹患者,无术后30 d内死亡患者。十二指肠乳头腺癌6例,胆总管下段腺癌5例,胰头导管腺癌2例,胰头浆液性囊腺瘤3例,胰头主胰管型导管内乳头状黏液瘤2例,十二指肠腺瘤伴高级别上皮内瘤变1例,胰头转移性肾透明细胞癌1例;胰腺质地柔软者5例、中等质地者12例、质地较硬者3例;远端胰管直径(2.1±1.7)mm。手术时间(380±69)min,胰肠吻合时间(29±15)min,术中出血量(180±150)mL,术后肛门排气时间(2.2±0.8)d,术后进食流质时间(3.5±1.1)d,术后进半流质时间(5.5±0.7)d,术后住院时间(14±10)d。术后2例患者共发生3次并发症,其中1例术后并发肺部感染,1例术后并发胃肠吻合口出血和胃排空延迟,均经保守治疗后好转出院;无胆汁漏、腹腔出血病例;术后并发胰瘘2例,均为生化胰瘘。结论“Double R”胰管空肠吻合方法具有操作方便、手术时间短、胰瘘发生率低等优点,但限于目前样本量较少,其安全性和可行性尚需积累更多中心、大样本病例资料来验证。Objective To investigate the clinical effect of“Double R”pancreatojejunostomy in laparoscopic pancreaticoduodenectomy(LPD).Methods The clinical data of 20 patients underwent“Double R”pancreaticojejunostomy in the LPD from November 2018 to December 2019 in this hospital were collected retrospectively.The duration of pancreaticojejunostomy,incidence of postoperative pancreatic fistula,incidence of other complications,mortality,length of stay,and other clinical outcomes were analyzed.Results There were 5 males and 6 females.The age was(56±10)years old.The body mass index was(22.6±4.4)kg/m^2.The LPDs were successfully performed in all 20 patients,no patient transferred to the laparotomy,and no patient died within 30 d.There were 6 patients with papillary adenocarcinoma of the duodenum,5 patients with adenocarcinoma of the lower part of the common bile duct,2 patients with adenocarcinoma of the pancreatic duct,3 patients with serous cystadenoma of the pancreatic head,2 patients with intraductal papillary myxoma of the main pancreatic duct of the pancreatic head,1 patient with duodenal adenoma with high grade intraepithelial neoplasia,1 patient with metastatic renal clear cell carcinoma of the pancreatic head,5 patients with soft pancreas,12 patients with medium texture,3 patients with hard texture.The diameter of distal pancreatic duct was(2.1±1.7)mm.The operative time was(380±69)min,the duration of pancreaticojejunostomy was(29±15)min,the intraoperative blood loss was(180±150)mL,the postoperative time of anal exhaust(2.2±0.8)d,postoperative time of fluid intake(3.5±1.1)d,postoperative time of half fluid intake(5.5±0.7)d,postoperative time of hospitalization(14±10)d.There were 3 complications in 2 patients,one of which suffered the pulmonary infection,the other suffered the delayed gastric emptying and gastrointestinal anastomosis bleeding,no bile leakage and abdominal hemorrhage happened.There were 2 cases of pancreatic fistula after the operation,all of them were biochemical pancreatic fistula.Conc

关 键 词：腹腔镜 胰十二指肠切除术 胰管空肠吻合术 胰瘘 

分 类 号：R657.5[医药卫生—外科学] R656.64[医药卫生—临床医学]