带蒂大网膜包裹胰肠吻合在胰十二指肠切除术中的应用  

Application of pedicled omentum wrapping pancreaticojejunostomy in pancreaticoduodenectomy

作　　者：刘蕾[1] 马睿锐[1] 汪洋[1] 贡海兵[1] 郭德凯 谌雁冰 江雨波 王从俊[2] Liu Lei;Ma Ruirui;Wang Yang;Gong Haibing;Guo Dekai;Chen Yanbing;Jiang Yubo;Wang Congjun(Department of Digestive Surgery,Songjiang Hospital Affiliated to Shanghai Jiao Tong University,Shanghai 201600,China;Department of Biliary and Pancreatic Surgery,Renji Hospital Affiliated to Shanghai Jiao Tong University,Shanghai 200127,China)

机构地区：[1]上海交通大学附属松江医院消化外科,上海201600 [2]上海交通大学附属仁济医院胆胰外科,上海200127

出　　处：《中华胰腺病杂志》2022年第2期123-126,共4页Chinese Journal of Pancreatology

基　　金：国家自然科学基金(81272534、30872510)。

摘　　要：目的探讨在胰十二指肠切除术中采用带蒂大网膜包裹联合改良胰肠吻合对预防胰瘘的作用。方法回顾性分析2017年9月至2020年8月间上海交通大学附属松江医院78例行胰十二指肠切除术患者的临床资料,根据手术方式不同分为单纯改良胰肠吻合组(常规组,43例)和带蒂大网膜包裹联合改良胰肠吻合组(网膜包裹组,35例),比较2组患者术后胰瘘、出血、胃排空障碍的发生情况及术后住院时间。结果与常规组比较,网膜包裹组的术后胰瘘发生率明显降低(2.9%比18.6%),差异有统计学意义(P=0.030);术后腹腔出血发生率(0比4.7%)及胃排空障碍发生率(8.6%比25.6%)均明显减少,但差异无统计学差异(P值均>0.05);术后住院时间缩短[(11.3±2.9)d比(12.8±3.5)d],差异有统计学意义(P=0.045)。结论带蒂大网膜包裹联合改良胰肠吻合术操作简单、易行,是一种有效的胰肠吻合方法,可显著降低胰腺切除患者术后胰瘘发生率,缩短患者术后住院时间。Objective To investigate the preventive effect of postoperative pancreatic fistula by pedicled omentum wrapping pancreaticojejunostomy in pancreaticoduodenectomy.Methods The clinical data of 78 patients who underwent pancreaticoduodenectomy in Songjiang Hospital Affiliated to Shanghai Jiao Tong University from September 2017 to August 2020 were retrospectively analyzed.Patients were divided into the modified pancreaticojejunostomy group(conventional approach group,n=43)and the pedicled omentum wrapping pancreaticojejunostomy group(omentum wrapping group,n=35)according to the surgical mode.Postoperative pancreatic fistula,postoperative abdominal bleeding,delayed gastric emptying and postoperative hospital stay were compared between the two groups.Results Compared with the conventional approach group,the postoperative pancreatic fistula rate in omentum wrapping group was significantly reduced(2.9%vs 18.6%),and the difference was statistically different(P=0.030);postoperative abdominal bleeding rate(0 vs 4.7%)and the delayed gastric emptying rate were significantly reduced(8.6%vs 25.6%),but both of them were not statistically different(all P value>0.05);the length of postoperative hospital stay was significantly reduced[(11.3±2.9)days vs(12.8±3.5)days],and the difference was statistically different(P=0.045).Conclusions The pedicled omentum wrapping pancreaticojejunostomy was simple and convenient,which can significantly reduce the rate of postoperative pancreatic fistula.It can shorten the time of the length of hospital stay after surgery.

关 键 词：外科手术 胰管空肠吻合术 腹膜 胰十二指肠切除术 

分 类 号：R657.5[医药卫生—外科学]