一期吻合联合T管造瘘在腹腔镜下十二指肠肿瘤局部切除术中的初步探索  

Primary exploration of stage I anastomosis and T-tube fistulation in laparoscopic local resection of duodenal tumors

作　　者：罗立杰 王涛 叶歆睿 王献哲 张焯铉 张子敬[1,2] 彭耀辉 陈妍 曾海平[1,2] 唐海鹏 林建涛 邹卫强 王伟 Luo Lijie;Wang Tao;Ye Xinrui;Wang Xianzhe;Zhang Zhuoxuan;Zhang Zijing;Peng Yaohui;Chen Yan;Zeng Haiping;Tang Haipeng;Lin Jiantao;Zou Weiqiang;Wang Wei(Department of Gastrointestinal Surgery,The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,China;Guangdong Clinical Research Academy of Chinese Medicine,Guangzhou 510405,China;Guangzhou University of Chinese Medicine,Guangzhou 510006,China;Department of General Surgery,Lufeng People's Hospital,Shanwei 516511,China;Department of Colorectal and Anal Surgery,Shaoguan First People's Hospital,Shaoguan 512099,China)

机构地区：[1]广州中医药大学第一附属医院胃肠外科,广州510405 [2]广东省中医临床研究院,广州510405 [3]广州中医药大学,广州510006 [4]广东省汕尾市陆丰市人民医院普通外科,汕尾516511 [5]广东省韶关市第一人民医院结直肠肛门外科,韶关512099

出　　处：《中华胃肠外科杂志》2025年第2期198-202,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：广东省中医药局项目(20211199);广州中医药大学第一附属医院国家中医药传承创新中心科研专项(2023QN11);国家自然科学基金资助项目(82205109);广州市科技局基础与应用基础研究项目(2025A04J3690);广州中医药大学第一附属医院中青年骨干培育项目(09005650055);广州中医药大学第一附属医院配套科研经费(09005647001)。

摘　　要：目的讨论一期吻合+T管造瘘术在腹腔镜下十二指肠肿瘤局部切除术中的可行性和安全性。方法采用描述性病例系列研究方法, 回顾性分析由广东省中医院和广州中医药大学第一附属医院2021年10月至2024年3月成功实施腹腔镜下十二指肠肿瘤局部切除一期吻合+T管造瘘术的14例十二指肠肿瘤患者的临床诊治资料。手术步骤如下:(1)明确安全切缘后, 全层完整切除十二指肠肿瘤, 标本袋取出标本送冰冻, 确定肿瘤性质及切缘阴性;(2)于肿瘤平面下方十二指肠前壁凿孔, 置入16#T管, 腹腔镜荷包缝合固定, 经十二指肠引出腹壁, 呈十二指肠T管造瘘术;(3)全层横形连续缝合十二指肠, 浆肌层加固, 形成一期吻合。主要观察患者术后营养改善情况, 并记录术中情况和术后并发症发生情况。结果 14例完成腹腔镜下十二指肠肿瘤局部切除一期吻合+T管造瘘术的患者均未出现中转开腹和术后急诊再手术及术中术后的相关并发症。手术时间为(225.4±56.5)min, 术中出血量为(72.1±74.6)ml。患者术后恢复良好, 无出现术后腹腔严重出血, 术后消化道造影提示吻合口通畅, 无狭窄及吻合口漏等相关并发症。患者术前与术后1周血清白蛋白[(37.09±3.53)g/L比(37.52±4)g/L]和血红蛋白[(100.79±31.93)g/L比(103.07±19.6)g/L], 差异均无统计学意义(P>0.05)。结论腹腔镜下十二指肠肿瘤局部切除一期吻合+T管造瘘术可作为十二指肠肿瘤局部切除术有效减少相关并发症发生的安全可行改良方法之一。Objective To discuss the feasibility and safety of stage I anastomosis and T-tube fistulation in laparoscopic local resection of duodenal tumors.Methods A descriptive case series study was used to retrospectively analyze the clinical diagnosis and treatment data of 14 patients with duodenal tumors who successfully underwent laparoscopic local resection of duodenal tumors+phase I anastomosis+T-tube ostomy in the Guangdong Provincial Hospital of Chinese Medicine and the First Affiliated Hospital of Guangzhou University of Chinese Medicine from October 2021 to March 2024.The resection and reconstruction steps of laparoscopic local resection of duodenal tumor+phase I anastomosis+T-tube ostomy are as follows:(1)after the safe margin is clear,the duodenal tumor is completely removed in full thickness,and the specimen bag is taken out and sent to frozen section to determine the nature of the tumor and the negative margin;(2)Perforate the anterior duodenal wall below the tumor plane,place a 16#T tube,and fix it with laparoscopic purse string suture.The abdominal wall is led out through the duodenum,and the duodenal T tube fistulation is performed;(3)The duodenum was continuously sutured in a full-thickness transverse shape,and the seromuscular layer was strengthened to form a phase I anastomosis.The nutritional improvement of patients after operation was mainly observed,and the intraoperative situation and postoperative complications were recorded.Results No conversion to laparotomy,postoperative emergency reoperation,intraoperative and postoperative complications occurred in 14 patients with duodenal tumors who completed laparoscopic local resection of duodenal tumors+phase I anastomosis+T-tube ostomy.The operation time was(225.43±56.54)min,and the intraoperative blood loss was(72.14±74.65)ml.The patient recovered well after operation,and no severe postoperative abdominal bleeding occurred.Postoperative gastrointestinal angiography showed that the anastomotic stoma was unobstructed,and there were no stenosis,anastomot

关 键 词：十二指肠肿瘤 局部切除 一期吻合 T管造瘘 腹腔镜手术 

分 类 号：R735.31[医药卫生—肿瘤]