一种改良胰肠吻合方式安全性及其在腹腔镜和开腹胰十二指肠切除术中应用比较  

Comparison of safety and efficacy of a modified pancreaticojejunostomy in laparoscopic and open pancreaticoduodenectomy

作　　者：陈卫波 朱玉文 杨豪 陆泽坤 邬迪 祖广晨 张悦[1] 陈学敏[1] Chen Weibo;Zhu Yuwen;Yang Hao;Lu Zekun;Wu Di;Zu Guangchen;Zhang Yue;Chen Xuemin(Department of Hepatobiliary and Pancreatic Surgery,the Third Affiliated Hospital of Soochow University(the First People's Hospital of Changzhou),Changzhou 213003,China)

机构地区：[1]苏州大学附属第三医院(江苏省常州市第一人民医院)肝胆胰外科,213003

出　　处：《中华肝脏外科手术学电子杂志》2024年第4期498-503,共6页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：江苏省“333”高层次人才培养工程(2022,3-4-086);常州市社会发展科技支撑项目(CE20225043);常州市卫生健康委员会重大科技项目(ZD202305,ZD202006);常州市“十四五”卫生健康高层次人才培养工程(2022260-67,2022260-14);常州市卫生青苗人才培养工程(CZQM2020005,CZQM2021002);常州市卫生健康委员会青年人才科技项目(QN202101)

摘　　要：目的探讨一种改良导管对黏膜胰肠吻合方式安全性及其在腹腔镜胰十二指肠切除术(LPD)和开腹胰十二指肠切除术(OPD)中应用的安全性和疗效。方法回顾性分析2021年1月至2022年12月在苏州大学附属第三医院行PD的162例患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男113例,女49例;平均年龄(66±11)岁。原发病:胰腺癌66例,胆管癌47例,十二指肠癌23例,壶腹部癌6例,胆囊癌1例,胃窦小弯侧腺癌1例,胰腺良性肿瘤18例。胰肠吻合方式均采用改良导管对黏膜胰肠吻合,其中95例行LPD(LPD组),67例行OPD(OPD组)。观察患者总体围手术期情况及术后并发症,评估吻合方式的安全性,并比较两组疗效。两组患者手术时间、术中出血量等比较采用t检验或秩和检验,两组胰瘘等并发症发生率比较采用χ^(2)检验或Fisher确切概率法。结果162例均手术成功,总体手术时间(317±71)min;术中出血量中位数140(100,200)ml,术后住院时间17(12,25)d;术后30 d死亡率0.6%(1/162),再手术率1.9%(3/162);术后B/C级胰瘘发生率24.7%(40/162),胃排空障碍发生率23.5%(38/162),腹腔感染发生率13.6%(22/162)。LPD组手术时间为(338±70)min,明显长于OPD组的(287±63)min(t=4.754,P<0.05);术中出血量为100(100,150)ml,明显少于OPD组的200(170,200)ml(Z=-6.075,P<0.05);术后住院时间为14(12,21)d,明显短于OPD组的18(12,33)d(Z=-2.040,P<0.05)。LPD组B/C级胰瘘发生率为17.7%(17/95),明显低于OPD组的34.3%(23/67)(χ^(2)=3.659,P<0.05)。结论改良导管对黏膜吻合患者术后总体胰瘘发生率较低,是一种安全、有效的胰肠吻合方式。与OPD比较,LPD可能手术时间长,但术后胰瘘发生率降低,同时具有微创优势,术后恢复较快,对于有经验团队,可以尝试。Objective To evaluate the safety and efficacy of a modified duct-to-mucosa pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy(LPD)and open pancreaticoduodenectomy(OPD).Methods Clinical data of 162 patients undergoing PD in the Third Affiliated Hospital of Soochow University from January 2021 to December 2022 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,113 patients were male and 49 female,aged(66±11)years on average.Primary diseases:66 patients were diagnosed with pancreatic cancer,47 cases of cholangiocarcinoma,23 cases of duodenal cancer,6 cases of ampullar cancer,1 case of gallbladder cancer,1 case of adenocarcinoma in the lesser curvature of gastric antrum and 18 cases of benign pancreatic tumors.A modified duct-to-mucosa pancreaticojejunostomy was adopted in the operations including 95 cases undergoing LPD(LPD group)and 67 cases of OPD(OPD group).The overall perioperative conditions and postoperative complications of all patients were observed.The safety and efficacy were compared between two groups.The operation time and intraoperative blood loss between two groups were compared by t test or rank-sum test.The incidence of postoperative complications,such as pancreatic fistula,between two groups was compared by Chi-square test or Fisher's exact test.Results All 162 patients successfully completed the surgery.The overall operation time was(317±71)min.The median intraoperative blood loss was 140(100,200)ml.The length of postoperative hospital stay was 17(12,25)d.The 30-d mortality rate was 0.6%(1/162).The re-operation rate was 1.9%(3/162).The incidence of postoperative grade B/C pancreatic fistula was 24.7%(40/162).The incidence of gastric emptying disorder was 23.5%(38/162).The incidence of abdominal infection was 13.6%(22/162).The operation time in the LPD group was(338±70)min,significantly longer than(287±63)min in the OPD group(t=4.754,P<0.05).Intraoperative blood loss in the LPD group was

关 键 词：胰十二指肠切除术 腹腔镜 胰肠吻合 导管对黏膜吻合 胰瘘 

分 类 号：R657.5[医药卫生—外科学]