胰十二指肠切除术中不同胰肠吻合术对患者围手术期指标和并发症的影响  

Effect of pancreaticojejunostomy with different anastomotic methods in pancreaticoduodenectomy on perioperative indexes and complications

作　　者：杨楠[1] 王庆大 孙楼宗 YANG Nan;WANG Qingda;SUN Louzong(Department of Hepatobiliary Surgery,Zigong First People’s Hospital,Zigong 643000,China)

机构地区：[1]自贡市第一人民医院肝胆外科,四川自贡643000

出　　处：《陕西医学杂志》2023年第12期1723-1726,共4页Shaanxi Medical Journal

基　　金：四川省自贡市重点科技计划项目(2016SF05)。

摘　　要：目的:探讨胰十二指肠切除术(PD)中不同胰肠吻合术对患者围手术期指标和并发症的影响。方法:选取行PD患者100例,根据术中吻合方式不同分为A组(胰管-空肠黏膜吻合术,53例)和B组(改良内陷式胰肠吻合术,47例)。比较两组患者围手术期相关指标、术后并发症发生情况、术后应激指标变化及手术结局。结果:B组患者胰肠吻合时间、住院时间短于A组患者,胰管直径小于A组患者(均P<0.05)。B组患者术后胰瘘和出血的发生率低于A组患者(均P<0.05)。两组患者术后第1天CRP、中性粒细胞比例及WBC比较差异无统计学意义(均P>0.05),术后第7天CRP、中性粒细胞比例及WBC低于术后第1天(均P<0.05)。术后第7天,B组CRP、中性粒细胞比例及WBC低于A组(均P<0.05)。两组患者术后病死率和再次手术率比较差异无统计学意义(均P>0.05)。结论:与胰管-空肠黏膜吻合术相比,改良内陷式胰肠吻合术操作简便,能够缩短吻合时间,术后瘘管和出血的发生率更低,应激反应更小,恢复更快,能明显缩短住院时间,安全性较高。Objective:To investigate the effect of pancreaticojejunostomy with different anastomotic methods in pancreaticoduodenectomy(PD)on perioperative indexes and complications.Methods:A total of 100 patients who underwent PD were selected and divided into group A(pancreatic duct-jejunal mucosal anastomosis,53 cases)and group B(modified invaginal pancreatico-intestinal anastomosis,47 cases)according to different intraoperative anastomosis methods.The perioperative related indicators,postoperative complications,changes in postoperative stress indicators and surgical outcomes were compared between the two groups.Results:The pancreaticojejunostomy time and length of hospital stay in group B were shorter than those in group A,and the diameter of pancreatic duct was smaller than that in group A(all P<0.05).The incidence of postoperative pancreatic fistula and bleeding in group B was lower than that in group A(all P<0.05).There were no significant differences in CRP,neutrophil ratio and WBC between the two groups on the 1st day after operation(all P>0.05),and CRP,neutrophil ratio and WBC on the 7th day after operation were lower than those on the first day after operation(all P<0.05).On the 7th day after operation,CRP,neutrophil ratio and WBC in group B were lower than those in group A(all P<0.05).There were no significant differences in postoperative mortality and reoperation rate between the two groups(both P>0.05).Conclusion:Compared with the pancreatic duct-jejunal mucosal anastomosis,the modified invaginal pancreatico-intestinal anastomosis is easier to perform,can shorten the anastomosis time,reduce the incidence of postoperative fistula and bleeding,reduce the stress response,and recover faster.It also can significantly shorten the length of hospital stay and is safe.

关 键 词：胰十二指肠切除术 胰肠吻合术 胰管-空肠黏膜吻合术 改良内陷式胰肠吻合术 围手术期 并发症 

分 类 号：R657.5[医药卫生—外科学]