陈氏胰肠吻合改良法在腹腔镜胰十二指肠切除术中的应用  

Application of a modified Chen's pancreaticojejunostomy to laparoscopic pancreaticoduodenectomy

作　　者：何龙 崔静 周笑笑 彭涛 赵传兵 卢煜 高安彤 殷涛 He Long;Cui Jing;Zhou Xiaoxiao;Peng Tao;Zhao Chuanbing;Lu Yu;Gao Antong;Yin Tao(Department of Pancreatic Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院胰腺外科,湖北武汉430022

出　　处：《腹部外科》2025年第1期15-19,共5页Journal of Abdominal Surgery

基　　金：国家自然科学基金(82173196);湖北省重点研发计划(2022BCA012)。

摘　　要：目的 探讨陈氏胰肠吻合改良法在腹腔镜胰十二指肠切除术中的应用价值。方法 回顾性收集2023年1月至2024年10月于华中科技大学同济医学院附属协和医院作者团队收治的121例腹腔镜胰十二指肠切除术病人资料,其中传统手术组63例,陈氏胰肠吻合改良组(改良手术组)58例,统计分析病人的性别、年龄、体重指数、手术时间、胰肠吻合时间、术中出血量、术后住院时间以及是否出现术后胰瘘、腹腔感染、腹腔出血、胃肠功能障碍、死亡等情况,并根据改良胰瘘风险评分系统(alternative pancreatic fistula risk score system,a-FRS)筛选胰瘘中高风险人群,比较在胰瘘中高风险人群中两种手术后胰瘘发生的风险。符合正态分布的计量资料以x±s表示,非正态分布资料以四分位数[M(Q1,Q3)]表示;计数资料采用例数表示。结果 改良手术组与传统手术组相比,手术时间较短[(311.8±55.0) min比(357.5±84.5) min,P=0.001],胰肠吻合时间也较短[15.5 (13.8,18.0)min比26.0 (23.0,29.0) min,P<0.001],临床相关术后胰瘘发生率较低[3.4%(2/58)比15.9%(10/63),P=0.022],而两组间病人年龄、性别、体重指数、胰瘘中高风险比例、术中出血量、术后住院时间差异均无统计学意义(均P>0.05),腹腔感染、腹腔出血、胃肠功能障碍发生率差异均无统计学意义(均P>0.05),两组均未出现围手术期死亡。根据a-FRS筛选出胰瘘中高风险人群62例,其中传统手术组中有34例,改良手术组中有28例,改良手术组胰瘘中高风险病人的手术时间、胰肠吻合时间仍较传统手术组胰瘘中高风险病人短(均P<0.05),改良手术组胰瘘中高风险病人术后胰瘘发生率仍低于传统手术组胰瘘中高风险病人(P=0.036)。结论 陈氏胰肠吻合改良法操作简单,胰肠吻合时间短,胰瘘发生率低,对胰瘘中高风险病人同样适用。Objective This study aims to assess the effectiveness of a modified Chen's pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy(LPD).Methods A retrospective analysis was conducted on the clinical data of 121 patients who underwent LPD at Union Hospital,Tongji Medical College,Huazhong University of Science and Technology between January 2023 and October 2024.The patients were divided into two groups:traditional surgery group(63 patients)and modified Chen's pancreaticojejunostomy(modified surgery group)(58 patients).Gender,age,body mass index(BMI),operation time,pancreatojejunostomy time,intraoperative blood loss,postoperative hospital stay,and the incidence of postoperative complications like pancreatic fistula,abdominal infection,intra-abdominal bleeding,gastrointestinal dysfunction,and mortality were compared between groups.Additionally,moderate-to-high risk patients for pancreatic fistula were identified using the alternative pancreatic fistula risk score system(a-FRS).The risk of pancreatic fistulas between groups was compared.Quantitative data adhering to a normal distribution were expressed as xˉ±s;otherwise,they were expressed as quartiles[M(Q1,Q3)].Count data were presented as the number of instances.Results Patients in the modified surgery group showed significantly shorter operation time(311.8±55.0 min vs.357.5±84.5 min,P=0.001)and pancreatojejunostomy time[15.5(13.8,18.0)min vs.26.0(23.0,29.0)min,P<0.001]compared to the traditional surgery group.The incidence of clinically relevant postoperative pancreatic fistula was also significantly lower in the modified surgery group than in the traditional surgery group[3.4%(2/58)vs.15.9%(10/63),P=0.022].There were no significant differences between the two groups in the age,gender,BMI,proportion of patients at moderate-to-high risk for pancreatic fistula,intraoperative blood loss,postoperative hospital stay,rates of abdominal infection,intra-abdominal bleeding,and gastrointestinal dysfunction(P>0.05).There were no perioperative deaths in both groups

关 键 词：腹腔镜 胰十二指肠切除术 陈氏胰肠吻合改良法 胰瘘 

分 类 号：R615[医药卫生—外科学]