PMOD刮吸解剖法在胰十二指肠切除术中的应用  

Application of the curettage and suction dissection method with PMOD in pancreaticoduodenectomy

作　　者：郭艳[1] 牛河源 李军[3] 孟兴凯[3] GUO Yan;NIU Heyuan;LI Jun;MENG Xingkai(Graduate School,Inner Mongolia Medical University,Hohhot 010050,China;Department of General Surgery,Tianjin Medical University General Hospital,Tianjin 300052,China;Department of Hepatobiliary Surgery,the Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010050,China)

机构地区：[1]内蒙古医科大学研究生院,内蒙古呼和浩特010050 [2]天津医科大学总医院普通外科,天津300052 [3]内蒙古医科大学附属医院肝胆外科,内蒙古呼和浩特010050

出　　处：《中国普通外科杂志》2024年第9期1451-1458,共8页China Journal of General Surgery

基　　金：内蒙古医科大学附属医院重大基金资助项目(NYFYZD2014005)。

摘　　要：背景与目的:严重和多发并发症是影响胰十二指肠切除术(PD)后患者生存的重要因素。既往的研究主要集中于消化道重建中吻合方式的改良,以改善术后瘘的发生,而从解剖层面去减少术后并发症的发生和改善患者预后研究较少。本文总结笔者团队在PD术中应用刮吸解剖法的经验,并分析其安全性和临床疗效。方法:回顾性收集2021年1月—2023年6月内蒙古医科大学附属医院肝胆外科收治的择期行PD患者的临床资料。将术中采用刮吸解剖法的患者作为观察组,术中采用传统解剖法的患者作为对照组。观察组患者术中使用彭氏多功能手术解剖器(PMOD)进行操作,对照组患者术中使用普通电刀和超声刀进行操作。比较两组患者的相关临床指标,并分析患者术后生存的影响因素。结果:共纳入169例患者,其中观察组59例,对照组110例。两组患者的一般资料差异无统计学意义(均P>0.05)。观察组术中的神经浸润情况多于对照组(64.41%vs.39.09%,P=0.002),但观察组的手术时间明显少于对照组(236.0 min vs.330.0 min,P<0.01),两组在淋巴结转移、出血量、血管浸润情况方面差异无统计学意义(均P>0.05)。观察组术后胰瘘的发生率明显低于对照组(16.9%vs.40.0%,P=0.002),两组患者的1个月内再手术率、术后住院时间、胆汁漏、出血、感染、胃排空延迟、生存情况方面差异无统计学意义(均P>0.05)。多因素Logistic回归分析结果显示,吸烟、肿瘤的神经浸润、术后胃排空延迟是影响生存的独立危险因素(均P<0.05)。结论:PMOD刮吸解剖法应用于PD是安全可行的。较传统解剖方法具有操作简单、创伤小,手术时间短、术后的优点。可间接减少术后相关并发症的发生情况。临床疗效可靠,可在临床中进行推广应用。Background and Aims:Severe and multiple complications significantly affect the survival of patients after pancreaticoduodenectomy(PD).Previous studies have primarily focused on improving anastomosis techniques to reduce postoperative fistulas,with limited research on anatomical approaches to decrease complications and improve patient outcomes.This article summarizes our team's experience in applying curettage and suction dissection method in PD and analyzes its safety and clinical efficacy.Methods:The clinical data from patients undergoing elective PD in the Department of Hepatobiliary Surgery of Inner Mongolia Medical University Hospital from January 2021 to June 2023 were retrospectively collected.Patients using the curettage and suction dissection method were designated as the observation group,while those using traditional anatomical techniques were served as the control group.The observation group utilized the Peng's multifunctional operational dissector(PMOD),whereas the control group used conventional electrotome and ultrasonic scalpel during operation.The main clinical variables between the two groups were compared,and factors affecting postoperative survival of patients were also analyzed.Results:A total of 169 patients were included,with 59 in the observation group and 110 in the control group.No significant differences in baseline characteristics were found between the groups(all P>0.05).The observation group exhibited more nerve infiltration during surgery than the control group(64.41%vs.39.09%,P=0.002),but had significantly shorter operative time(236 min vs.330 min,P<0.01).There were no significant differences in lymph node metastasis,blood loss,or vascular infiltration between the two groups(all P>0.05).The incidence of postoperative pancreatic fistula was significantly lower in the observation group than that in the control group(16.9%vs.40.0%,P=0.002).No significant differences were noted between the groups in terms of reoperation rate within one month,postoperative hospitalization duration,bile l

关 键 词：胰十二指肠切除术 手术后并发症 彭氏多功能手术解剖器 

分 类 号：R657.5[医药卫生—外科学]