完全腹腔镜胰十二指肠切除术中两种胰肠吻合方式的对比研究  

A retrospective comparative study of two types of pancreaticojejunostomy in total laparoscopic pancreaticoduodenectomy

作　　者：周海华 俞世安 吴晓康 厉学民 Zhou Haihua;Yu Shian;Wu Xiaokang;Li Xuemin(The First Department of Hepatopancreatobiliary Surgery,the Affiliated Jinhua Hospital of Zhejiang University School of Medicine,Jinhua 321000,China)

机构地区：[1]浙江大学医学院附属金华医院肝胆胰外科一区,金华321000

出　　处：《中华肝胆外科杂志》2022年第4期245-249,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：浙江省医药卫生科技计划项目(2020KY1005);金华市科技计划项目(2020-3-048)。

摘　　要：目的对比完全腹腔镜下胰十二指肠切除术中双荷包桥接式和导管对黏膜式两种胰肠吻合方式的临床效果,探讨双荷包桥接式胰肠吻合在腹腔镜胰十二指肠切除术中应用的可行性。方法回顾性分析2016年1月至2021年8月浙江大学医学院附属金华医院采用双荷包桥接式胰肠吻合或导管对黏膜胰肠吻合的行腹腔镜胰十二指肠切除术患者的临床资料。纳入93例行腹腔镜胰十二指肠切除术的患者,其中男性48例,女性45例,年龄(62±10)岁。依据吻合方式分为两组:采用双荷包桥接式胰肠吻合的患者作为双荷包组(n=51),采用导管对黏膜胰肠吻合的患者作为导管对黏膜组(n=42)。对比两组患者的临床资料。结果93例患者均在完全腹腔镜下顺利完成手术,术后3个月内均无死亡病例。与导管对黏膜组相比,双荷包组胰肠吻合时间[(32.41±8.75)比(47.62±8.90)min]和手术时间[(365.75±43.74)比(389.07±45.31)min]均缩短,差异具有统计学意义(P<0.05)。双荷包组胰瘘发生率9.8%(5/51)与导管对黏膜组7.1%(3/42)比较,差异无统计学意义(P>0.05)。双荷包组中胰管直径>3 mm的患者为18例,3例患者发生了B级胰瘘,胰瘘发生率为16.6%(3/18);导管对黏膜组中胰管直径>3 mm的患者为11例,0例患者发生了B级胰瘘,胰瘘发生率为0(0/11)。结论与导管对黏膜吻合相比,双荷包桥接式胰肠吻合在腹腔镜胰十二指肠切除术中的操作简单,胰肠吻合时间短,尤其适用于胰腺导管不扩张的患者。Objective To compare the clinical outcomes of a double purse-string and bridging technique versus duct-to-mucosal pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy.Methods The clinical data of patients who underwent laparoscopic pancreaticoduodenectomy using the double purse-string and bridging pancreaticojejunostomy technique versus those who underwent duct-to-mucosa pancreaticojejunostomy at the Affiliated Jinhua Hospital of Zhejiang University School of Medicine from January 2016 to August 2021 were retrospectively analyzed.Of the 93 patients who underwent laparoscopic pancreaticoduodenectomy,there were 48 males and 45 females,with age of(62±10)years old.These patients were divided into two groups:patients who underwent double purse-string and bridging pancreaticojejunostomy(the double purse-string group,n=51),and patients who underwent duct-to-mucosa pancreaticojejunostomy(the duct-to-mucosa group,n=42).The clinical data of the two groups were compared.Results All the 93 patients underwent laparoscopic pancreaticoduodenectomy successfully,and there were no deaths within 3 months of operation.Compared with the duct-to-mucosa group,the double purse-string group had significantly shorter time of pancreaticojejunal anastomosis[(32.41±8.75)vs.(47.62±8.90)min]and time of operation[(365.75±43.74)vs.(389.07±45.31)min](all P<0.05).The postoperative pancreatic fistula rates were 9.8%(5/51)in the double purse-string group and 7.1%(3/42)in the duct-to-mucosa group.There was no significant difference between the two groups(P>0.05).In the double purse-string group,there were 18 patients with a pancreatic duct diameter>3 mm,and 3 of these patients developed grade B pancreatic fistula,giving a grade B pancreatic fistula rate of 16.6%(3/18).In the duct-to-mucosa group,there were 11 patients with a pancreatic duct diameter>3 mm,and no patients developed grade B pancreatic fistula,giving a pancreatic fistula rate of 0(0/11).Conclusion Compared with the duct-to-mucosa anastomosis,the double purse string and bri

关 键 词：腹腔镜检查 胰十二指肠切除术 吻合术 外科 

分 类 号：R657.5[医药卫生—外科学]