胰十二指肠切除术后腹腔最佳引流区域的前瞻性队列研究  

Optimal drainage area of abdominal cavity after pancreatoduodenectomy:a prospective cohort study

作　　者：李秦屹 张显赫 邰国凯 李飞 王志东[1] Li Qinyi;Zhang Xianhe;Tai Guokai;Li Fei;Wang Zhidong(Department of Biliary and Pancreatic Surgery,the 2nd Hospital of Harbin Medical University,Heilongjiang Harbin 150086,China)

机构地区：[1]哈尔滨医科大学附属第二医院胆胰外科,黑龙江哈尔滨150086

出　　处：《腹部外科》2025年第1期30-36,共7页Journal of Abdominal Surgery

摘　　要：目的 研究胰十二指肠切除术(pancreaticoduodenectomy,PD)术后腹腔积液最容易蓄积的区域。方法 该项是前瞻性队列研究,收集哈尔滨医科大学附属第二医院2022年10月至2024年8月期间收治的106例行PD病人的术后引流情况、术后腹水淀粉酶指标以及术后CT等影像学资料,依据PD术后腹腔引流放置区域不同分为Ⅰ组、Ⅱ组和Ⅲ组(第Ⅱ组与第Ⅰ组区别在于将第2根引流管从胰肠吻合口头侧放置于胰肠吻合口背侧,第Ⅰ组与第Ⅲ组的区别是第Ⅰ组在第Ⅲ组的基础上增加了1根引流胰肠吻合口腹侧区域的引流管),其中Ⅰ组28例,Ⅱ组33例,Ⅲ组45例。比较3组中各区域术后引流、腹腔积液情况以及腹水淀粉酶指标。先进行正态性Shapiro-Wilk检验,对于服从或近似正态分布的计量资料采用x±s表达,采用t检验;对于不符合正态性分布的连续变量,采用M(Q1,Q3)表达;计数资料的组间比较采用χ2检验;不同时间、组间的交互作用下水平采用重复测量方差分析,多组间(3组及3组以上)比较采用单因素方差分析。结果 在术后总积液量方面,Ⅰ组中胆肠吻合口区域(A区域)最少[(239.08±168.68) mL],胰肠吻合口头侧区域(B区域)最多[(627.32±195.56) mL],差异有统计学意义(P<0.05);Ⅱ组中A区域最少[(227.52±129.35) mL],胰肠吻合口背侧区域(D区域)最多[(646.19±250.92) mL],差异有统计学意义(P<0.05);而Ⅲ组中A区域[(111.83±52.62) mL]少于B区域[(563.12±275.73) mL],差异有统计学意义(P<0.05)。在腹水淀粉酶值方面,Ⅰ组中A区域最低[40.5(15.75,104.5) U/L],胰肠吻合口腹侧区域(C区域)最高[187.5(58.5,2 118.25) U/L],差异有统计学意义(P<0.05);Ⅱ组中A区域最低[88.0(29.5,173.0)U/L],C区域[510.0(65.0,1 850.0) U/L]和D区域[406.0(75.5,1 342.5) U/L]均较高,三者间差异有统计学意义(P<0.05),C区域与D区域间差异无统计学意义(P>0.05);Ⅲ组中A区域[75.0(33.5,344.5)U/L]低于B区域[409.0(79.5,898.0)UObjective To investigate the areas where postoperative abdominal fluid is most likely to accumulate after pancreaticoduodenectomy(PD).Methods Postoperative drainage,ascitic amylase levels,and postoperative imaging data,including CT scans in 106 patients who underwent PD at the 2nd Hospital of Harbin Medical University between October 2022 and August 2024 were prospectively analyzed.Patients were categorized into three groups based on the placement of abdominal drains:GroupⅠ,GroupⅡ,and GroupⅢ.The difference between GroupⅠand GroupⅡwas the placement of the second drainage tube,which in GroupⅡwas positioned at the dorsal side of the pancreaticojejunostomy,and the oral side in GroupⅠ.The difference between GroupⅠand GroupⅢwas the placement of an additional drain at the ventral side of the pancreaticojejunostomy in GroupⅠ.Finally,GroupⅠconsisted of 28 patients,GroupⅡhad 33 patients,and GroupⅢincluded 45 patients.Postoperative drainage,abdominal fluid accumulation,and ascitic amylase levels were compared across these groups.The Shapiro-Wilk test was performed for testing the normality.Continuous variables that followed or approximately followed a normal distribution were expressed as x±s,and compared by the t-test.Continuous variables did not conform to a normal distribution were expressed as median(Q1,Q3)and compared by the chi-square test.Repeated measures analysis of variance(ANOVA)was applied to assess the interaction effects across different time points and groups.For comparisons among three or more groups,one-way ANOVA was used.Results GroupⅠshowed the least total postoperative fluid accumulation in the biliary-enteric anastomosis(region A)(239.08±168.68 mL)and the most fluid accumulation in the head side of the pancreatic-enteric anastomosis(region B)(627.32±195.56 mL)(P<0.05).In GroupⅡ,the least total postoperative fluid accumulation was found in region A(227.52±129.35 mL),and the most accumulation was detected in the back side of the pancreatic-enteric anastomosis(region D)(64

关 键 词：胰十二指肠切除术 腹腔引流 腹腔积液 胰瘘 

分 类 号：R61[医药卫生—外科学] R657.5[医药卫生—临床医学]