胰腺残端经腹壁悬吊技术在腹腔镜胰十二指肠切除术胰肠吻合中的应用价值  

Application value of pancreatic stump suspension technique via abdominal wall in pancreaticojejunostomy during laparoscopic pancreaticoduodenectomy

作　　者：张健[1] 朱霄峰 曹国良 韩春蕃[1] 谢平[1] 吴小昌[1] ZHANG Jian;ZHU Xiaofeng;CAO Guoliang;HAN Chunfan;XIE Ping;WU Xiaochang(Department of Hepatobiliary and Pancreatic Surgery,Huzhou Central Hospital,Huzhou 313000,China)

机构地区：[1]湖州市中心医院肝胆胰外科,313000

出　　处：《浙江医学》2024年第18期1949-1953,1958,I0004,共7页Zhejiang Medical Journal

基　　金：湖州市公益性应用研究项目(2021GYB24)。

摘　　要：目的探讨胰腺残端经腹壁悬吊技术在腹腔镜胰十二指肠切除术(LPD)胰肠吻合中的应用价值。方法回顾性分析2014年1月至2024年6月湖州市中心医院由同一手术团队完成的87例行LPD患者的临床资料。其中胰肠吻合术时行胰腺残端经腹壁悬吊患者45例(悬吊组),未进行悬吊患者42例(常规组)。比较两组患者术前一般资料(年龄、BMI、实验室检查、基础疾病等)、术中指标(胰腺质地、肿瘤直径、胰管直径、胰肠吻合时间、术中出血量、手术时间)和术后指标(术后病理检查、淋巴结转移情况、术后并发症、术后住院时间、住院费用)。进一步采用单因素和多因素logistic回归分析发生术后胰瘘(POPF)的影响因素。结果两组患者术前一般资料比较差异均无统计学意义(均P>0.05);术中指标比较发现,两组患者胰腺质地、肿瘤直径、胰管直径和术中出血量方面比较差异均无统计学意义(均P>0.05),但悬吊组胰肠吻合时间和手术时间均明显优于常规组(均P<0.05)。术后指标比较发现,两组患者术后病理检查、淋巴结转移、术后并发症和住院费用方面比较差异均无统计学意义(均P>0.05),但悬吊组术后住院时间短于常规组(P<0.05)。多因素logistic回归分析提示胰管直径是LPD患者发生POPF的危险因素,而胰腺质地软是保护因素(均P<0.05)。结论胰腺残端经腹壁悬吊技术在胰肠吻合时暴露充分,操作方便,吻合口质量高,该技术能够缩短胰肠吻合时间和手术时间,安全有效,值得临床推广。Objective To investigate the application value of pancreatic stump suspension technique through abdominal wall in pancreaticojejunostomy during laparoscopic pancreaticoduodenectomy(LPD).Methods The clinical data of 87 patients who underwent LPD by the same surgical team in Huzhou Central Hospital from January 2014 to June 2024 were retrospectively analyzed.There were 45 patients who underwent pancreatic stump suspension through the abdominal wall during pancreaticointestinal anastomosis(suspension group),and 42 patients who did not undergo suspension(conventional group).The preoperative general data(age,body mass index,laboratory examination,underlying diseases),intraoperative indicators(pancreatic texture,tumor diameter,pancreaticojejunostomy time,blood loss volume,and operation time),and postoperative indicators(postoperative pathology,lymph node metastasis,postoperative complications,postoperative hospital stay,and hospitalization expenses)were compared between the two groups.Univariate and multivariate logistic regression was used to analyze the independent risk factors of postoperative pancreatic fistula(POPF).Results There were no significant differences in preoperative general data between the two groups(all P>0.05),neither were in pancreatic texture,tumor diameter,pancreatic duct diameter and intraoperative blood loss volume between the two groups(all P>0.05).However,the pancreaticojejunostomy time and operation time in the suspension group were both significantly shorter than those in the conventional group,with statistically significant differences(both P<0.05).No significant differences were observed between the two groups in postoperative pathology,lymph node metastasis,postoperative complications and hospitalization costs(P>0.05).However,the postoperative hospital stay in the suspension group was shorter than that of the conventional group,and the difference was statistically significant(P<0.05).Multivariate logistic regression analysis showed that pancreatic duct diameter was high risk factors for P

关 键 词：胰十二指肠切除术 胰肠吻合 胰腺残端悬吊 腹腔镜 胰瘘 

分 类 号：R657.5[医药卫生—外科学]