改良的胰胃吻合技术在腹腔镜保留十二指肠的胰头切除术中的应用  

Application of a modified pancreatogastric anastomosis in laparoscopic duodenum-preserving pancreatic head resection

作　　者：秦建章[1] 于灏天 刘学青[1] 周新博 何伟 梁云飞 张晴 刘建华[1] Qin Jianzhang;Yu Haotian;Liu Xueqing;Zhou Xinbo;He Wei;Liang Yunfei;Zhang Qing;Liu Jianhua(Department of Hepatobiliary Surgery,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Taihang Community Health Service Center,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院肝胆外科,石家庄050000 [2]太行社区卫生服务中心,石家庄050000

出　　处：《中华肝胆外科杂志》2023年第12期927-931,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨改良的胰胃吻合技术在腹腔镜保留十二指肠的胰头切除术(LDPPHR)中的应用效果。方法回顾性分析2019年1月至2023年5月在河北医科大学第二医院肝胆外科行LDPPHR的25例胰头部良性或低度恶性肿瘤患者的病例资料,其中男性7例,女性18例,年龄(44.9±6.2)岁。根据术中胰腺消化道重建方式的不同,分为两组:采用改良的胰胃吻合技术治疗的患者10例纳入观察组,采用胰肠吻合+空肠-空肠吻合技术治疗的患者15例纳入对照组。统计并比较两组患者的一般资料、术中胰腺消化道重建时间、术后3 d内腹腔引流液淀粉酶最大值、术后并发症、术后住院时间等。结果所有患者均顺利完成手术。观察组术中胰腺消化道重建时间短于对照组[(27.8±2.4)min比(45.8±3.6)min],差异具有统计学意义(P=0.010)。观察组和对照组患者的术中出血量分别为(140.5±14.8)ml和(145.2±9.7)ml,两组比较,差异无统计学意义(P=0.843)。观察组术后3 d内腹腔引流液淀粉酶最大值低于对照组[(809.1±185.5)U/L比(1385.4±481.1)U/L],差异具有统计学意义(P=0.031)。观察组术后住院时间短于对照组[(7.9±1.3)d比(10.3±2.7)d],差异具有统计学意义(P=0.017)。术后并发症方面,两组均无C级胰瘘及术后出血发生,观察组B级胰瘘发生率低于对照组[20.0%(2/10)比60.0%(9/15)],差异具有统计学意义(P=0.048)。25例患者中位随访时间为15.6个月,两组均无因胰瘘、出血以及消化道功能障碍导致生活质量下降或二次手术者。结论在LDPPHR中,相对于胰肠吻合,改良的胰胃吻合技术具有消化道重建时间短,术后胰瘘风险低的优点。Objective To study the feasibility of a modified pancreatogastric anastomosis in laparoscopic duodenum preserving pancreatic head resection(LDPPHR).Methods The clinical data of 25 patients with benign or low-grade malignant tumors of pancreatic head undergoing LDPPHR at the Second Hospital of Hebei Medical University from January 2019 to May 2023 were retrospectively analyzed,including 7 males and 18 females,aged(44.9±6.2)years old.According to the methods of pancreatic digestive reconstruction,patients were divided into the observation group(n=10),who underwent the modified pancreatogastric anastomosis,and the control group(n=15)who underwent conventional pancreaticojejunal anastomosis and jejuno-jejunal anastomosis.The general data,intraoperative pancreatic digestive reconstruction time,maximum levels of amylase in abdominal drainage within three days postoperatively,postoperative complications,and hospital stay were compared between the groups.Results All procedures were performed successfully.The intraoperative pancreatic digestive reconstruction time was shorter in the observation group[(27.8±2.4)min vs.(45.8±3.6)min,P=0.010].The intraoperative blood loss were comparable between the groups[(140.5±14.8)ml vs.(145.2±9.7)ml,P=0.843].The maximum level of amylase in abdominal drainage within three days postoperatively was lower in the observation group[(809.1±185.5)U/L vs.(1385.4±481.1)U/L,P=0.031].No grade C pancreatic fistula or postoperative hemorrhage occurred in either group,and the incidence of grade B pancreatic fistula was lower in the observation group[20.0%(2/10)vs.60.0%(9/15),P=0.048],with a shorter postoperative hospital stay[(7.9±1.3)d vs.(10.3±2.7)d,P=0.017].No decrease of life quality or reoperation due to pancreatic fistula,hemorrhage or digestive tract malfunction occurred in either group within a median follow-up of 15.6 months.Conclusion In LDPPHR,the modified pancreatogastric anastomosis could help shorten the pancreatic digestive reconstruction and lower the risk of postoperative pan

关 键 词：吻合术 外科 腹腔镜保留十二指肠的胰头切除术 胰肠吻合 胰腺肿瘤 

分 类 号：R657.5[医药卫生—外科学]