胰管包裹式胰肠吻合法在腹腔镜胰十二指肠切除术中的应用价值:附132 例分析  

Clinical application of “enfolded pancreatic duct” pancreaticojejunostomy during laparoscopic pancreaticoduodenectomy:analysis of 132 cases

作　　者：黄小兵 贺永刚 唐艺宸 李靖 HUANG Xiaobing;HE Yonggang;TANG Yichen;LI Jing(Department of Hepatobiliary Surgery,Xinqiao Hospital,Army Medical University,Chongqing 400037,P.R.China)

机构地区：[1]陆军军医大学新桥医院肝胆外科,重庆400037

出　　处：《中国普外基础与临床杂志》2022年第10期1261-1265,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：国家自然科学基金资助项目(项目编号:81672902)。

摘　　要：目的 探索胰管包裹式胰肠吻合在腹腔镜胰十二指肠切除术中的应用价值。方法 回顾性收集2020年5月至2022年3月期间陆军军医大学新桥医院开展的腹腔镜胰十二指肠切除且采用胰管包裹式胰肠吻合患者的临床病理资料,记录术中胰肠吻合时间和术后30 d内胰漏、胆汁漏、乳糜漏、出血、腹腔内感染、死亡等情况。结果 共收集到132例患者,其中男60例,女72例;年龄(58.6±10.9)岁。恶性肿瘤95例,包括胰头癌38例、十二指肠癌17例、下段胆管癌17例、十二指肠乳头癌23例;良性及交界性肿瘤37例,包括胰腺神经内分泌瘤7例、胰腺导管内乳头状瘤11例、十二指肠间质瘤5例、十二指肠乳头状腺瘤5例、胰腺囊腺瘤6例、胰头结石3例。术前胰管直径(3.43±2.11)mm,其中<3 mm者31例。无一例患者中转开腹,胰肠吻合时间(20.61±3.16)min。术后发生胰漏17例(其中A级11例、B级6例),胆汁漏1例,乳糜漏6例,术后出血5例(腹腔内出血2例、胃肠吻合口出血3例),腹腔内感染3例,无围术期死亡病例。术后随访90 d内无因并发症再次入院患者。结论 从本组病例结果看,胰管包裹式胰肠吻合较传统胰管空肠黏膜吻合操作步骤更简单,手术难度下降,能缩短胰肠吻合手术时间,降低胰漏发生率,尤其适合在腹腔镜下应用。Objective To explore the application value of “enfolded pancreatic duct”pancreaticojejunostomy(PJ) during laparoscopic pancreaticoduodenectomy(LPD). Methods The clinicopathologic data of patients underwent LPD and “enfolded pancreatic duct” PJ from May 2020 to March 2022 were collected retrospectively. The time of PJ was recorded. And the pancreatic leakage, biliary leakage, chyle leakage, bleeding and infection, and death within 30 d after the operation were observed. Results A total of 132 patients were collected, including 60 males and 72females. The age of patients was(58.6±10.9) years old. There were 38 cases of pancreatic head cancer, 17 cases of duodenum carcinoma, 17 cases of inferior segment cholangiocarcinoma, and 23 cases of duodenal papilla carcinoma, 7cases of pancreatic neuroendocrine tumor, 11 cases of pancreatic intraductal papilloma, 5 cases of duodenal stromal tumor, 5 cases of duodenal papillary adenoma, 6 cases of pancreatic cyst adenoma, and 3 cases of pancreatic head stone.None of the patients was converted to open surgery. The diameter of pancreatic duct before operation was(3.43±2.11)mm, which were <3 mm in 31 cases. The time of PJ was(20.61±3.16) min. The pancreatic leakage occurred in 17 cases,including 11 cases of grade A leakage, 6 cases of grade B leakage, and none of grade C leakage. There was 1 case of bile leakage, 6 cases of chyle leakage, 5 cases of postoperative bleeding(2 cases of intraabdominal bleeding and 3 cases of gastrointestinal anastomotic bleeding), 3 cases of intraabdominal infection, and no death. None of the patients was readmission due to complications after 90 d of follow-up. Conclusions From summary results of this group of cases,compared with the traditional PJ method, “enfolded pancreatic duct” PJ is less difficult and simpler to operate, which can obviously shorten the PJ time during LPD and reduce the incidence of pancreatic leakage. It is especially suitable for laparoscopic application.

关 键 词：胰管包裹式胰肠吻合 腹腔镜 胰十二指肠切除术 胰漏 

分 类 号：R657.5[医药卫生—外科学]