“一针法”胰肠吻合方式在腹腔镜胰十二指肠切除术中的初期应用体会  

Initial application of"one stitch method"pancreaticoenterostomy in laparoscopic pancreaticoduodenectomy

作　　者：王志成 秦锡亮 金浩 刘会春 王勇 庞青 胡小四 潘洪涛 朱超 陈石磊 周帅 汪玲 WANG Zhicheng;QIN Xiliang;JIN Hao(Graduate school,Bengbu Medical College,Bengbu 233030,China;Department of Hepatobiliary Pancreatic Surgery,Anhui No.2 Provincial People’s Hospital)

机构地区：[1]蚌埠医学院研究生院,安徽蚌埠233030 [2]安徽省第二人民医院普外四病区肝胆胰外科 [3]中国人民解放军联勤保障部队九〇二医院神经外科

出　　处：《腹腔镜外科杂志》2024年第2期86-90,97,共6页Journal of Laparoscopic Surgery

基　　金：安徽省卫健委科研项目(AHWJ2022b032);安徽省教育厅重点项目(2022AH052337);蚌埠医学院研究生科研创新计划立项项目(Byycx23120)。

摘　　要：目的:探讨“一针法”胰肠吻合方式在腹腔镜胰十二指肠切除术(LPD)中的初期应用效果。方法:回顾分析2019年1月至2019年12月应用洪德飞教授创作的“一针法”进行胰肠吻合的34例LPD患者的临床资料。结果:34例患者均顺利完成LPD,手术时间305.0(280.0,327.5)min,胰肠吻合时间41.5(38.0,45.0)min,术中出血量210.0(172.5,243.8)mL,术后住院13.5(10.3,15.8)d。术后胰瘘发生率14.7%(5/34),其中B级胰瘘4例,C级胰瘘1例;胆漏发生率5.9%(2/34);胃排空延迟发生率11.8%(4/34),其中A级3例,B级1例,未出现C级;出血发生率为8.8%(3/34),腹腔感染率2.9%(1/34),切口感染率5.9%(2/34),二次手术率2.9%(1/34);围手术期无死亡病例。结论:“一针法”应用于LPD开展初期是安全、可靠的,可有效降低手术难度,对于LPD初学者平稳度过学习曲线具有一定帮助,值得初学者学习与推广。Objective:To investigate the initial application effect of"one stitch method"in the laparoscopic pancreatoduodenectomy(LPD).Methods:Clinical data of 34 LPD patients who underwent pancreaticoenterostomy with the"one stitch method"created by professor Hong Defei were retrospectively analyzed from Jan.2019 to Dec.2019.Results:LPD was successfully performed in 34 patients.The operation time was 305.0(280.0,327.5)min,the pancreaticojejunostomy time was 41.5(38.0,45.0)min,the intraoperative blood loss was 210.0(172.5,243.8)mL,and the postoperative hospital stay was 13.5(10.3,15.8)d.The incidence of postoperative pancreatic fistula was 14.7%(5/34),including 4 cases of grade B pancreatic fistula and 1 case of grade C pancreatic fistula.The incidence of biliary leakage was 5.9%(2/34).The incidence of delayed gastric emptying was 11.8%(4/34),including 3 cases of grade A,1 case of grade B and 0 case of grade C.The incidence of bleeding was 8.8%(3/34).The incidence of abdominal infection was 2.9%(1/34).The incidence of incision infection was 5.9%(2/34).Reoperation was performed in 2.9%patients(1/34).There was no perioperative death.Conclusions:The application of“one stitch method”in the early stage of LPD is safe and reliable,can e ffectively reduce the difficulty of surgery,and has certain help for LPD beginners to smoothly overcome the early learning curve,which is worthy of learning and promotion for LPD beginners in clinical work.

关 键 词：胰十二指肠切除术 腹腔镜检查 一针法 胰瘘 

分 类 号：R657.5[医药卫生—外科学]