不同胰肠吻合法在胰十二指肠切除术中的前瞻性对比研究  

Different pancreaticoduodenectomy methods in pancreaticoduodenectomy

作　　者：刘月生[1] 李国林[2] 曾海锋[1] 陈文[1] 区锦玲[1] 林福臻 Liu Yuesheng;Li Guolin;Zeng Haifeng;Chen Wen;Qu Jinling;Lin Fuzhen(Department of General Surgery,Zhaoqing First People's Hospital,Zhaoqing Guangdong Province 526000,China;Department of Hepatobiliary and Pancreatic Surgery,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou Guangdong Province 510000,China)

机构地区：[1]肇庆市第一人民医院普通外科,广东肇庆526000 [2]中山大学孙逸仙纪念医院肝胆胰外科,广州510000

出　　处：《中华普外科手术学杂志（电子版）》2022年第3期327-330,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：广东省自然科学基金项目(2019A030312762)。

摘　　要：目的探讨不同胰肠吻合法在胰十二指肠切除术(PD)中的临床应用效果。方法前瞻性研究2015年1月至2020年12月96例不同胰肠吻合法在PD中的临床应用效果,并采用随机数字表法将患者分为A组、B组和C组,每组32例,A组采用胰管空肠黏膜吻合法,B组采用Blumgart吻合法,C组采用改良Blumgart吻合法。应用统计软件SPSS 22.0进行数据分析,计数资料行x检验,计量资料采用(x±s)表示,多组间比较行单因素方差分析,两组间比较行LSD-t检验。P<0.05表示差异有统计学意义。比较各组患者围手术期指标、术后并发症及生活质量。结果三组手术时间及胰肠吻合时间比较,C组<B组<A组(P<0.05);三组患者术后出血、腹腔感染、胃瘫及胆瘘情况比较,差异无统计学意义(P>0.05),但B组、C组患者术后生化瘘及B级胰瘘的发生率显著低于A组(P<0.05)。三组患者术后3个月生活质量综合评定问卷(GQ0LI-74)各项评分比较,B组、C组患者的各项评分均明显高于A组(P<0.05)。结论在PD中采用Blumgart吻合法及其改良法不仅简化了手术操作,而且有效降低了术后胰瘘的发生,改善了患者术后生活质量,且改良Blumgart吻合法相较于Blumgart吻合法操作更为简便,具有更高的临床应用价值。Objective To investigate the clinical effects of different pancreaticojejunostomy methods in pancreaticoduodenectomy(PD).Methods The clinical effects of 96 patients with different pancreaticojejunostomy in PD from January 2015 to December 2020 were prospectie studied.The patients were divided into group A,group B and group C by random number table method,each of 32 patients.Group A was treated with pancreaticojejunostomy,group B with Blumgart anastomosis,and group C with modified Blumgart anastomosis.SPSS 22.0 was used for data analysis.x2 test.measurement data were expressed by(x±s).One-way ANOVA was performed for comparison between multiple groups,and LSD-t test was performed for comparison between two groups.P<O.05 indicated statistically significant difference.Perioperative indexes,postoperative complications and quality of life of each group were compared.Results The operation time and pancreaticoenterostomy time of the three groups were compared,Group C<group B<group A(P<O.05).There was no significant difference in postoperative bleeding,abdominal infection,gastroparesis and biliary fistula among the three groups(P>O.05),but the incidence of biochemical fistula and grade B pancreatic fistula in group B and group C was significantly lower than that in group A(P<O.05).The scores of gQOLI-74 were significantly higher in group B and group C than in group A(P<O.05).Conclusion Blumgart anastomosis method and its improvement not only simplified the operation,but also effectively reduced the incidence of postoperative pancreatic fistula and improved the quality of life of patients.In addition,the modified Blumgart anastomosis method is easier to operate than the Blumgart anastomosis method and has higher clinical application value.

关 键 词：胰十二指肠切除术 胰管空肠吻合术 疗效比较研究 

分 类 号：R47[医药卫生—护理学]