应用网膜垫技术行腹腔镜胰十二指肠切除术临床研究  

Application of omental flap technique in laparoscopic pancreaticoduodenectomy

作　　者：孟思嘉 李少栋 牟一平[3] 金巍巍[3] 任宇峰 鲁超[3] MENG Si-jia;LI Shao-dong;MOU yi-ping(Bengbu Medical College,Bengbu 233030,China)

机构地区：[1]蚌埠医学院,安徽蚌埠233030 [2]绍兴市中心医院,浙江绍兴312030 [3]浙江省人民医院(杭州医学院附属人民医院)胃肠胰外科,浙江省胃肠病学重点实验室,浙江杭州310014 [4]浙江中医药大学,浙江杭州310053

出　　处：《中国实用外科杂志》2022年第5期580-584,共5页Chinese Journal of Practical Surgery

基　　金：国家卫生健康委科学研究基金-浙江省卫生健康重大科技计划(No.WKJ-ZJ-2201);浙江省科技厅“领雁”重大社会公益项目(No.2022C03099)。

摘　　要：目的总结腹腔镜胰十二指肠切除术(LPD)中应用网膜垫技术的临床疗效。方法回顾性分析2015年5月至2021年1月浙江省人民医院胃肠胰腺外科行LPD 298例病人临床资料。根据是否使用网膜垫技术分为网膜垫组(171例)和对照组(127例),比较两组术后主要并发症发生率,并对术后迟发性出血进行单因素及多因素分析。结果网膜垫组术后总体并发症发生率(28.1%vs.44.1%),术后严重并发症(Clavien-Dindo分级≥Ⅲ级,7.6%vs.15.7%)发生率均低于对照组(P<0.05)。且网膜垫组并发B、C级胰漏8例(4.7%),术后迟发性出血9例(5.3%),均显著低于对照组的18例(14.0%)、16例(12.6%)(P<0.05)。单因素分析显示疾病良恶性、胰腺质地、胰管直径和网膜垫技术与LPD术后迟发性出血的发生相关。多因素分析提示,应用网膜垫技术是LPD术后迟发性出血的独立因素(P<0.05)。结论网膜垫技术可降低LPD术后总并发症发生率,尤其降低术后严重并发症发生,可能是LPD术后迟发性出血的保护因素。Objective To investigate the clinical efficacy of performing the omental flap technique during laparoscopic pancreaticoduodenectomy(LPD).Methods The clinical data of 298 patients who performed LPD in the Gastroenteropancreatic Surgery Department of Zhejiang Provincial People’s Hospital between May 2015 and January2021 were collected and analyzed retrospectively.The patients were divided into the omental group(171 cases)and control group(127 cases)based on the application of the omental flap technique or not.And the perioperative outcomes were compared between these two groups,moreover,univariate and multivariate analysis on delayed postoperative hemorrhage(POPH)was performed to conclude.Results The overall postoperative complication rate(28.1%vs.44.1%)and severe complications(Clavien-Dindo≥Ⅲ,7.6%vs.15.7%)were much lower in the omental group than that of the control group(P<0.05).B and C grade pancreatic leakage[8 cases(4.7%)vs.18 cases(14.0%)]and delayed POPH[9 cases(5.3%)vs.16 cases(12.6%)]in the omental group than that of the control group(P<0.05).Univariate analysis revealed that benign or malignant pathology,pancreatic texture,the diameter of pancreatic duct,and omental flap technique increased the risk of POPH.Furthermore,multivariate analysis indicated that the application of omental flap technique played as an independent protective factor of delayed POPH(P<0.05).Conclusion The omental flap technique can reduce the overall complication rate after LPD,especially for the serious complications.And it may be a protective factor for delayed POPH.

关 键 词：大网膜 腹腔镜胰十二指肠切除术 胰漏 出血 

分 类 号：R6[医药卫生—外科学]