不同胰肠吻合方式对胰十二指肠切除术后胰瘘的影响  

The Effect of Different Pancreaticoenteric Anastomotic Techniques on Postoperative Pancreatic Fistula Following Pancreaticoduodenectomy

作　　者：陈琳光 唐冠杰 康庆民[1] 李剑[1] CHEN Linguang;TANG Guanjie;KANG Qingmin(The Affiliated Hospital of Chengde Medical University,Hebei Chengde 067000,China)

机构地区：[1]承德医学院附属医院肝胆外科,河北承德067000

出　　处：《河北医学》2023年第11期1886-1891,共6页Hebei Medicine

基　　金：承德市科学技术研究与发展计划,(编号:202006A087)。

摘　　要：目的:探讨两种不同胰肠吻合方式对胰十二指肠切除术后胰瘘发生率的影响。方法:回顾性分析承德医学院附属医院2020年1月至2022年12月行胰十二指肠切除术患者的临床资料。根据胰肠吻合方式不同分为两组:“陈氏”胰肠吻合组(陈氏组,n=21)和“洪氏-针法”胰肠吻合组(洪氏组,n=44)。比较两组患者术前疾病状态、术后胰瘘情况、手术失血、住院时间、住院花费等指标。并采用多因素Logistic回归分析,探讨各指标对胰瘘等并发症发生风险的影响。结果:两组患者术前胰管直径无统计学差异(P>0.05)。术前胆红素水平、术前行胆道引流者洪氏组高于陈氏组(P<0.05)。与陈氏组比较,洪氏组患者失血量、住院时间、住院花费显著升高,有统计学差异(P<0.05);洪氏组患者术后胰瘘发生率显著升高,有统计学差异(56.82%vs 14.29%χ^(2)=10.49,P=0.001)。多因素Logistic回归分析显示,两组患者在术前胆红素水平、术前胆道引流、手术失血量、住院时间、住院花费方面无统计学意义(P>0.05),陈氏组胰瘘发生率低于洪氏组(P<0.05)。结论:陈氏胰肠吻合法术后胰瘘发生风险低,值得临床推广应用。Objective:To investigate the effect of two different pancreaticoenteric anastomotic techniques on postoperative pancreatic fistula(POPF)after pancreaticoduodenectomy.Methods:A retrospective analysis of clinical data from patients undergoing pancreaticoduodenectomy at the Affiliated Hospital of Chengde Medical College from January 2020 to December 2022 was conducted.Patients were divided into two groups based on different pancreaticojejunostomy techniques:the"Chen's"pancreaticojejunostomy group(Chen's group,n=21)and the"Hong's one-stitch method"pancreaticojejunostomy group(Hong's group,n=44).The preoperative disease status,POPF,intraoperative bleeding,length of hospital stay,and hospitalization cost were compared between the two groups.Multivariate Logistic regression analysis was used to explore the effect of various indicators on the risk of complications such as pancreatic fistula.Results:There was no statistical significant difference in the size of pancreatic duct between the two groups(P>0.05).The preoperative bilirubin level and biliary drainage in Hong's group were higher than those in Chen's group(P<0.05).Intraoperative blood loss,length of hospital stay and hospitalization cost in Chen's group were lower than those in Hong's group(P<0.05).The POPF incidence in Chen's group was significantly lower than in Hong's group(56.82%vs 14.29%;χ^(2)=10.49,P=0.001).Multivariate Logistic regression showed that there was no statistical significance in preoperative bilirubin level,biliary drainage,intraoperative blood loss,length of hospital stay and hospitalization cost between the two groups(P>0.05).Compared with Hong's group,Chen's group decease the incidence of POPF(P<0.05).Conclusion:Chen's pancreaticojejunostomy technique is associated with a lower risk of pancreatic fistula after pancreaticoduodenectomy,and it is worthy of clinical promotion and application.

关 键 词：胰十二指肠切除术 胰腺瘘 胰肠吻合 

分 类 号：R657.5[医药卫生—外科学]