涤纶垫片加强胰十二指肠切除术中胰肠吻合的初步临床研究  

A preliminary clinical study of polyester spacer-enhanced pancreatico-intestinal anastomosis in pancreaticoduodenectomy

作　　者：李鑫[1] 王嘉毅 李少华[2] 朱瑞利 贾振飞[2] 马成云 王现兵[2] Li Xin;Wang Jiayi;Li Shaohua;Zhu Ruili;Jia Zhenfei;Ma Chengyun;Wang Xianbing(The Peoples Hospital of Anyang City,Xinxiang Medical University,Anyang 455000,China;Department of Hepatobiliary and Pancreatic Surgery,the Peoples Hospital of Anyang City,Anyang 455000,China)

机构地区：[1]新乡医学院安阳市人民医院培养基地,安阳455000 [2]安阳市人民医院肝胆胰外科,安阳455000

出　　处：《中华肝胆外科杂志》2024年第1期44-49,共6页Chinese Journal of Hepatobiliary Surgery

基　　金：河南省科技攻关-联合共建项目(LHGJ20191275)。

摘　　要：目的:探讨将涤纶垫片用于加强传统胰十二指肠切除术中胰肠吻合,从而预防术后胰瘘的安全性与实用性。方法:回顾性分析2018年8月至2023年8月安阳市人民医院由同一主刀医师完成的82例胰十二指肠切除术的患者临床资料,其中男性52例,女性30例,年龄(62.21±9.75)岁。根据是否在胰肠吻合中使用涤纶垫片将患者分为试验组( n=40)与对照组( n=42),对两组的围术期数据进行比较,并利用Logistic分析影响术后胰瘘的危险因素。 结果:两组患者在胆瘘、肠瘘、腹腔感染、腹腔出血、术后死亡率方面差异无统计学意义(均 P>0.05)。试验组术后胰瘘发生率20.0%(8/40)低于对照组的45.2%(19/42),差异有统计学意义( P=0.015)。胰腺质地较软( OR=16.595,95% CI:1.891~145.657)是发生术后胰瘘的独立危险因素,而使用涤纶垫片的改良胰肠吻合方式( OR=0.332,95% CI:0.114~0.969)可降低发生术后胰瘘的风险。 结论:在胰十二指肠切除术中使用涤纶垫片加强胰肠吻合能降低术后胰瘘发生率,具有较好的安全性和实用性。Objective To investigate the safety and utility of using polyester spacers in conventional pancreatico-enteric anastomosis in pancreaticoduodenectomy to achieve prevention of postoperative pancreatic fistula.MethodsThe clinical data of 82 patients with pancreaticoduodenectomy completed by the same physician in Anyang People's Hospital from August 2018 to August 2023 were retrospectively analyzed,including 52 males and 30 females,aged(62.21±9.75)years.They were divided into two groups,test group(n=40)and control group(n=42)according to whether polyester spacers were used in pancreatico-intestinal anastomosis,the perioperative data of the two groups were compared,and Logistic analysis was used to analyze the risk factors affecting postoperative pancreatic fistula.ResultsThere was no statistically significant difference between the two groups in terms of biliary fistula,intestinal fistula,abdominal infection,abdominal bleeding,and postoperative mortality rate(all P>0.05).The incidence of postoperative pancreatic fistula in the test group was 20.0%(8/40)which was lower than that in the control group 45.2%(19/42),and the difference was statistically significant(P=0.015).Soft pancreas texture(OR=16.595,95%CI:1.891~145.657)was an independent risk factor for postoperative pancreatic fistula,while improved pancreatic enterostomy with polyester spacers(OR=0.332,95%CI:0.114~0.969)could reduce the risk of postoperative pancreatic fistula.ConclusionUse of polyester spacers to reinforce the pancreatico-enteric anastomosis during pancreaticoduodenectomy reduces the incidence of postoperative pancreatic fistulae with good safety and practicality.

关 键 词：胰十二指肠切除术 胰肠吻合 涤纶垫片 胰瘘 

分 类 号：R656.64[医药卫生—外科学] R657.5[医药卫生—临床医学]