肝胃韧带包裹肝动脉预防胰十二指肠切除术后肝动脉及其分支出血的疗效  

The efficacy of wrapping the hepatic artery with the hepatogastric ligament in preventing bleeding of the hepatic artery and its branches after pancreaticoduodenectomy

作　　者：余金 朱媛 占学志 廖晓锋[2] 李晓刚[2] YU Jin;ZHU Yuan;ZHAN Xuezhi;LIAO Xiaofeng;LI Xiaogang(School of Medicine,Faculty of Medicine,Wuhan University of Science and Technology,Wuhan 430065,China;不详)

机构地区：[1]武汉科技大学医学部医学院,430065 [2]湖北文理学院附属襄阳市中心医院胆胰外科

出　　处：《临床外科杂志》2025年第3期295-298,共4页Journal of Clinical Surgery

摘　　要：目的总结采用肝胃韧带包裹肝动脉预防胰十二指肠切除术(PD)术后肝动脉及其分支出血的临床效果。方法2017年1月~2024年11月行PD病人194例,按术中是否采用肝胃韧带包裹肝动脉分为两组,包裹组95例,采用肝胃韧带包裹肝动脉;非包裹组99例,不包裹肝动脉。比较两组术中指标(术中出血量、手术时间)和术后并发症(胰瘘、腹腔感染、胆瘘、胃排空障碍、术后出血及术后肝动脉及其分支出血)。采用单因素和多因素Logistic回归分析术后出血的独立危险因素。结果非包裹组及包裹组均顺利完成PD,两组术中出血量和手术时间比较差异无统计学意义(P>0.05),术后并发胰瘘、腹腔感染、胆瘘和胃排空障碍等比较差异无统计学意义(P>0.05),但包裹组术后出血率低于非包裹组(3.16%和12.12%,P<0.05),且包裹组术后肝动脉及其分支出血率明显低于非包裹组(0和10.10%,P<0.05)。Logistic回归分析显示,手术时间(OR=1.013,P=0.011)、胰瘘(OR=9.006,P=0.006)和腹腔感染(OR=7.930,P=0.014)是术后出血的独立危险因素,而肝胃韧带包裹肝动脉是PD术后出血的独立保护因素(OR=0.084,P=0.006)。结论用肝胃韧带包裹肝动脉能降低PD术后出血率,尤其可显著减少术后肝动脉及其分支出血,且无其他并发症新增风险。Objective To investigate the clinical efficacy of wrapping the hepatic artery with the hepatogastric ligament for preventing bleeding of the hepatic artery and its branches following pancreaticoduodenectomy(PD).Methods 194 patients who underwent PD in Xiangyang Central Hospital from January 2017 to November 2024 were enrolled and categorized into two groups based on whether the hepatic artery was enwrapped with the hepatogastric ligament during the operation.The wrapped group consisted of 95 cases where the hepatic artery was wrapped,while the non-wrapped group had 99 cases without such wrapping.Intraoperative parameters(intraoperative blood loss and operative time)and postoperative complications(pancreatic fistula,abdominal cavity infection,biliary fistula,delayed gastric emptying,postoperative bleeding,and bleeding of the hepatic artery and its branches)were compared between the two cohorts.Univariate and multivariate Logistic regression analyses were conducted to identify the independent risk factors for postoperative bleeding.Results PD was accomplished successfully in both groups.There was no remarkable difference in intraoperative indices like blood loss and operative time between the two groups(P>0.05).Similarly,no significant disparities were noted in postoperative complications such as pancreatic fistula,abdominal infection,biliary fistula,and delayed gastric emptying(P>0.05).Nevertheless,the incidence of postoperative bleeding in the wrapped group was lower than that in the non-wrapped group(3.16%vs.12.12%,P=0.019),and the incidence of bleeding of the hepatic artery and its branches after surgery was also significantly decreased in the wrapped group(0 vs.10.10%,P=0.004).Logistic regression analysis revealed that the operation time(OR=1.013,P=0.011),pancreatic fistula(OR=9.006,P=0.006)and celiac infection(OR=7.930,P=0.014)are independent risk factors of postoperative bleeding,Hepatogastric ligament encapsulation of hepatic artery was an independent protective factor for postoperative hemorrhage of PD(OR=

关 键 词：胰十二指肠切除术 术后出血 肝动脉 

分 类 号：R47[医药卫生—护理学]