胃肠重建方式的优化对胰十二指肠切除术后胃排空障碍的影响  

Effect of optimizing gastrointestinal reconstruction on reducing gastric emptying disorder after pancreaticoduodenectomy

作　　者：刘磊 谢坤[1] 刘付宝[1] 李子寒 赵义军[1] 张昭文 耿小平[1] Liu Lei;Xie Kun;Liu Fubao;Li Zihan;Zhao Yijun;Zhang Zhaowen;Geng Xiaoping(Department of Hepatobiliary and Pancreatic Surgery,High-tech Branch Zone,Department of General Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230000,China)

机构地区：[1]安徽医科大学第一附属医院普外科(高新院区肝胆胰外科),合肥230000

出　　处：《中华普通外科杂志》2022年第9期651-654,共4页Chinese Journal of General Surgery

基　　金：安徽高校自然科学研究项目(KJ2021ZD0021)。

摘　　要：目的探讨术中胃肠重建方式的优化对胰十二指肠切除术后胃排空障碍的影响。方法回顾性分析安徽医科大学第一附属医院肝胆胰外科2019年1月至2020年12月146例行胰十二指肠切除患者的临床资料,78例消化道重建采用传统BillrothⅡ式胃空肠吻合,68例采取优化的胃肠吻合方式。观察两组病例的术后肛门排气时间、进流食时间及并发症情况等。结果对照组手术时间为(351.4±71.6)min,少于改良组的(368.8±97.6)min,但进普食时间[(9.9±6.5)d比(7.6±6.0)d]、术后住院时间[(20.7±8.6)d比(17.9±7.0)d]显著长于改良组,术后胃排空障碍发生率明显高于改良组(19.2%比7.4%),差异有统计学意义(均P<0.05)。两组病例的术后肛门排气时间、术后消化道出血等指标差异无统计学意义(均P>0.05)。结论在胰十二指肠切除术中优化胃肠重建的措施可以减少胃排空障碍,促进胃肠功能恢复。Objective To investigate the effect of optimizing perioperative measures on reducing postoperative gastric emptying disorder in gastrointestinal reconstruction after pancreaticoduodenectomy.Methods The clinical data of 146 patients who underwent pancreaticoduodenectomy from Jan 2019 to Dec 2020 at the Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital,Anhui Medical University were analyzed retrospectively.Among them,78 cases underwent traditional BillrothⅡgastrojejunal anastomosis for gastrointestinal reconstruction,and 68 cases in the improvement group took optimization measures.The time to first postoperative flatus,time to oral intake,postoperative hospital stay and complications were observed.Results The operation time in the control group was(351.4±71.6)min,less than that in the improved group(368.8±97.6)min,while the time[(9.9±6.5)d vs.(7.6±6.0)d]to first oral take and postoperative hospital stay[(20.7±8.6)d vs.(17.9±7.0)d]were significantly longer than those in the improved group.The incidence of postoperative gastric emptying disorder(19.2%vs.7.4%)was significantly higher than that in the improved group(P<0.05).There was no significant difference in postoperative time to first flatus and postoperative gastrointestinal bleeding between the two groups(all P>0.05).Conclusions The measures of optimizing gastrointestinal reconstruction in the perioperative period of pancreaticoduodenectomy have obvious advantages in reducing gastric emptying disorder,promoting the recovery of gastrointestinal function and shortening the length of hospital stay.

关 键 词：胰十二指肠切除术 吻合术 外科 胃排空障碍 

分 类 号：R657.5[医药卫生—外科学]