"二针法"在腹腔镜手术纤细胰管对空肠吻合中的应用  

Application of the"two-stitch"fashion in laparoscopic pancreaticojejunostomy for patients with fine pancreatic duct

作　　者：李仓 吴晓康 胡伟建 厉学民 周海华 范恒丹 俞世安 Li Cang;Wu Xiaokang;Hu Weijian;Li Xuemin;Zhou Haihua;Fan Hengdan;Yu Shian(Department of Hepatobiliary and Pancreatic Surgery,Jinhua Hospital Affiliated to Medical College of Zhejiang University,Jinhua 321000,China)

机构地区：[1]浙江大学医学院附属金华医院肝胆胰外科,金华321000

出　　处：《中华肝胆外科杂志》2025年第3期193-196,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：金华市科技计划重大项目(2023-3-066);金华市科技计划公益项目(2022-4-114)。

摘　　要：目的分析"二针法"在腹腔镜手术纤细胰管(胰管直径<3 mm)对空肠吻合中的应用效果。方法回顾性分析2021年4月至2024年6月在浙江大学医学院附属金华医院行腹腔镜手术采用"二针法"行胰肠吻合且胰管纤细(胰管直径<3 mm)的32例患者资料,其中男性20例,女性12例,年龄(61.2±23.7)岁。32例患者中23例(71.9%)为壶腹周围肿瘤,9例(28.1%)为胰腺中段肿瘤。32例患者均采用"二针法"行胰肠吻合,即腹背侧各一针的胰腺导管对空肠黏膜吻合,其中行腹腔镜胰十二指肠切除(LPD)的胰肠吻合23例(71.9%),腹腔镜胰腺中段切除(LCP)的胰肠吻合9例(28.1%)。记录患者的手术时间、胰肠吻合时间、术后住院时间、术后并发症(胰瘘、胆漏、腹腔感染等)和围手术期死亡情况等。结果32例患者均顺利完成腹腔镜"二针法"纤细胰管胰肠吻合,其中LPD的胰肠吻合23例(71.9%),LCP的胰肠吻合9例(28.1%)。32例患者的手术时间为(279.3±115.8)min,胰肠吻合时间为(31.9±12.2)min,术后住院时间为(13.4±8.3)d。术后出现B级胰瘘6例(18.8%)(LPD 4例,LCP 2例),胃排空延迟1例(3.1%),腹腔感染3例(9.4%)(LPD 2例,LCP 1例),胆瘘2例(6.3%)(LPD),无C级胰瘘患者,所有患者术后并发症均通过保守治疗治愈。结论"二针法"行腹腔镜手术纤细胰管对空肠吻合是安全有效的。Objective To evaluate the feasibility of"two-stitch"fashion in laparoscopic pancreaticojejunostomy(PJ)for patients with fine pancreatic duct(<3 mm).Methods Clinical data of 32 patients with pancreatic duct diameter<3 mm undergoing laparoscopic PJ using the"two-stitch"fashion between Apr 2021 and Jun 2024 were retrospectively analyzed,including 20 males and 12 females,aged(61.2±23.7)years.Among the patients,there were 23(71.9%)patients of periampullary tumor and 9(28.1%)of central pancreatic tumor.23(71.9%)patients underwent laparoscopic pancreatoduodenectomy(LPD)and nine(28.1%)underwent laparoscopic central pancreatectomy(LCP).All patients underwent the"two-stitch"fashion of laparoscopic PJ(one stitch each on the ventral and dorsal sides of pancreas for duct-to-mucosal anastomosis).The operation time,PJ time,postoperative hospital stay,postoperative complications(pancreatic fistula,gallbladder leakage,abdominal cavity infection,etc)and mortality were recorded.Result All patients underwent the"two stitch"laparoscopic PJ successfully,23(71.9%)patients underwent laparoscopic pancreatoduodenectomy(LPD)and nine(28.1%)underwent laparoscopic central pancreatectomy(LCP).The operation time was(279.3±115.8)min,the PJ time was(31.9±12.2)min,and the postoperative hospital stay was(13.4±8.3)d.Grade B pancreatic fistula occurred in six cases(18.8%,four of LPD and two of LCP),delayed gastric emptying in one case of LPD(3.1%),abdominal infection in three cases(9.4%,two of LPD and one of LCP),biliary fistula in two cases(6.3%,LPD).There were no grade C pancreatic fistula.All patients with postoperative complications were managed with conservative treatment.Conclusion Laparoscopic"two stitch"PJ for patients with fine pancreatic duct(<3 mm)is safe and feasible.

关 键 词：腹腔镜 纤细胰管 胰管空肠吻合术 

分 类 号：R657.5[医药卫生—外科学]