后壁加固缝合改良胰肠吻合对行胰十二指肠切除术治疗的胰腺癌患者术中出血量及术后恢复进程的影响  

Effect of retro-wall reinforcement sutured modified pancreatic enterostomy on intraoperative blood loss and postoperative recovery in pancreatic cancer patients undergoing pancreaticoduodenectomy

作　　者：陈广野 李少华[1] CHEN Guangye;LI Shaohua(General Surgery Department of Anyang People's Hospital,Anyang 455000,China)

机构地区：[1]安阳市人民医院普外科,河南安阳455000

出　　处：《山东第二医科大学学报》2024年第6期440-443,共4页Journal of Shandong Second Medical University

基　　金：河南省医学科技攻关计划(联合共建)项目(项目编号:LHGJ20191275)。

摘　　要：目的观察后壁加固缝合改良胰肠吻合对行胰十二指肠切除术治疗的胰腺癌患者术中出血量及术后恢复进程的影响。方法收集2020年3月~2023年3月本院医治的78例胰腺癌患者的临床资料,根据不同手术方法分为2组,各39例。常规吻合组实施胰十二指肠切除(PD)后进行常规黏膜吻合,改良吻合组行后壁加固缝合改良胰肠吻合。比较两组手术指标,术后恢复状况,手术前后氧化应激反应,包括谷胱甘肽过氧化物酶(GSH-PX)、肾上腺素(E),去甲肾上腺素(NE)水平,术后各时间段视觉模拟法(VAS)评分及并发症状况。结果与常规吻合组相比,改良吻合组手术时间、胰肠吻合时间均较短,术中输血率、出血量均较少(P<0.05);术后,与常规吻合组相比,改良吻合组住院时间、下床活动时间、术后进食时间、排便时间均较短(P<0.05);术后3d,与常规吻合组相比,改良吻合组血清E、GSH-PX、NE水平均较低(P<0.05);与常规吻合组相比,改良吻合组术后VAS评分较低(P<0.05);改良吻合组并发症发生率(2.56%)与常规吻合组(5.13%)相比,差异无统计学意义(P>0.05)。结论胰腺癌患者采用PD术中行后壁加固缝合改良胰肠吻合术,可缩短手术时间,减少术中出血量,减轻术后疼痛感,改善氧化应激水平,促进术后快速恢复。Objective To investigate the effects of retro-wall reinforcement and modified pancreatic enterostomy on intraoperative blood loss and postoperative recovery in pancreatic cancer patients undergoing pancreaticoduodenectomy.Methods A total of 78 patients with pancreatic cancer admitted to our hospital from March 2020 to March 2023 were divided into 2 groups with 39 cases each according to different surgical methods.Conventional mucosal anastomosis was performed after pancreaticoduodenectomy(PD)in the conventional anastomosis group,and modified pancreatico-enteric anastomosis was performed in the modified anastomosis group with posterior wall reinforcement suture.The surgical indexes,postoperative recovery status,pre-and postoperative oxidative stress,glutathione peroxidase(GSH-PX),epinephrine(E),norepinephrine(NE)levels,visual analog method(VAS)scores at each postoperative period,and the status of complications were compared between the two groups.Results Compared with the conventional anastomosis group,the modified anastomosis group had shorter operation time,shorter pancreatic-intestinal anastomosis time,lower intraoperative blood transfusion rate,and less bleeding(P<0.05);postoperatively,compared with the conventional anastomosis group,the modified anastomosis group had shorter hospitalization time,shorter time to get out of bed,shorter time to eat,and shorter time to defecate postoperatively(P<0.05);in the 3d postoperative period,compared with the conventional anastomosis group,the modified anastomosis group had lower serum E,GSH-PX,and NE levels were lower(P<0.05);postoperative VAS scores were lower in the modified anastomosis group compared with the conventional anastomosis group(P<0.05);and there was no statistically significant difference in the complication rate of the modified anastomosis group(2.56%)compared with that of the conventional anastomosis group(5.13%)(P>0.05).Conclusion PD can shorten the operation time,reduce the amount of blood loss,relieve postoperative pain,improve the level of oxidative s

关 键 词：胰腺肿瘤 改良胰肠吻合 常规黏膜吻合 恢复进程 术中出血量 

分 类 号：R736.7[医药卫生—肿瘤]