双针全层胰肠吻合术在腹腔镜胰十二指肠切除术中的效果及对术后胰瘘发生率、围术期死亡率的影响  

Effect of Double-needle Full-thickness Pancreatic Enterotomy in Laparoscopic Pancreaticoduodenectomy and its Effect on the Incidence of Postoperative Pancreatic Fistula and Perioperative Mortality

作　　者：陈国利[1] 郑志方[1] 胡文靖 于爱军[1] 岳秋菊[1] 崔淼航[1] CHEN Guoli;ZHENG Zhifang;HU Wenjing;YU Aijun;YUE Qiuju;CUI Miaohang(Affiliated Hospital of Chengde Medical College,Chengde 067000,China;Pingquan Hospital of Traditional Chinese Medicine,Pingquan 067500,China)

机构地区：[1]承德医学院附属医院,河北承德067000 [2]河北省平泉市中医院,河北平泉067500

出　　处：《中国临床医生杂志》2022年第12期1421-1424,共4页Chinese Journal For Clinicians

基　　金：河北省自然科学基金资助项目(H2021406047);河北省承德市科学技术研究与发展计划项目(202109A190)。

摘　　要：目的 探讨双针全层胰肠吻合术在腹腔镜胰十二指肠切除术(laparoscopic pancreaticoduodenectomy,LPD)中的应用效果及对术后胰瘘(postoperative pancreatic fistula,POPF)发生率、围术期死亡率的影响。方法 选取2020年2月至2022年3月承德医学院附属医院行LPD治疗的胰头良恶性占位病变患者92例。根据治疗方法分为观察组46例(行双针全层胰肠吻合术)和对照组46例(行传统胰管空肠黏膜端侧吻合术)。比较两组术中情况(胰管空肠吻合时间、出血量、手术时间)、术后情况(术后胃肠减压时间)、并发症(POPF、胆瘘、胃排空障碍、腹腔内出血)及预后情况(再次手术、围术期死亡)。结果 两组出血量、手术时间、术后胃肠减压时间、再次手术发生率及胆瘘、胃排空障碍、腹腔内出血的发生率方面比较,差异均无显著性(P>0.05)。观察组胰管空肠吻合时间短于对照组,围术期死亡率明显低于对照组,差异有显著性(P<0.05);观察组POPF总发生率、B、C级POPF发生率均明显低于对照组,差异有显著性(P<0.05),两组A级POPF发生率差异无显著性(P>0.05)。结论 双针全层胰肠吻合术应用于LPD有效、安全,可有效降低POPF的发生率及围术期的死亡率。Objective To investigate the effect of double-needle full-thickness pancreatic anastomosis in laparoscopic pancreaticoduodenectomy(LPD) and its effect on the incidence and perioperative mortality of postoperative pancreatic fistula(POPF). Method A total of 92patients with benign and malignant mass lesions of the pancreatic head who underwent LPD treatment in the Affiliated Hospital of Chengde Medical College from February 2020 to March 2022 were enrolled. According to the treatment method, 46 cases were divided into observation group(double-needle full-thickness pancreatic anastomosis) and 46 cases in the control group(traditional pancreatic ductjejunal mucosal end-side anastomosis). The intraoperative conditions(pancreatic ductjejunal anastomosis time, bleeding volume,operation time), postoperative situation(postoperative gastrointestinal decompression time), complications(POPF, biliary fistula, gastric emptying disorder, intra-abdominal bleeding) and prognosis(reoperation, perioperative death) were compared between the two groups.Result There were no significant differences in the amount of bleeding, operation time, postoperative gastrointestinal decompression time,reoperation rate, and incidence of biliary fistula, gastric emptying disorder, and intra-abdominal bleeding between the two groups(P>0.05). The pancreatic ductjejunal anastomosis time in the observation group was shorter than that in the control group, and the perioperative mortality rate was significantly lower than that in the control group, with a significant difference(P<0.05), while the total incidence of POPF and grade B and C POPF in the observation group were significantly lower than that in the control group, with significant differences(P<0.05), and there was no significant difference in the incidence of grade A POPF between the two groups(P>0.05). Conclusion Double-needle full-thickness pancreatic intestinal anastomosis is effective and safe for LPD, and can effectively reduce the incidence of POPF and perioperative mortality.

关 键 词：胰十二指肠切除术 腹腔镜 双针全层胰肠吻合术 胰管空肠黏膜端侧吻合术 术后胰瘘 死亡率 

分 类 号：R657.5[医药卫生—外科学]