探究胰胃吻合在腹腔镜胰十二指肠切除术(LPD)的临床疗效，分析引起胃排空障碍(DGE)的影响因素。

回顾性分析2015年1月至2018年3月60例接受LPD的资料，根据术中消化道重建方式不同分为胰胃吻合(PG)和胰肠吻合(PJ)两组。PG组28例，PJ组32例。使用SPSS 21.0统计学软件进行分析，围手术指标、营养指标等采用(±s)表示，采用独立t检验；并发症发生率采用χ²检验。利用单/多因素进行分析，探究影响胃排空障碍的危险因素，P<0.05认为差异有统计学意义。

两组均顺利完成手术，无中转开腹病例；PG组近期并发症6例(21.4%)，远期1例(3.6%)；PJ组近期并发症12例(37.5%)，远期4例(12.5%)；PG组近、远期并发症少于PJ组(P<0.05); 60例PD患者术后共8例(13.3%)发生胃排空障碍，单因素分析发现，吻合方式、术后出血、胰瘘是引发胃排空障碍的影响因素(P<0.05)。多因素分析发现，胰瘘是引发胃排空障碍的独立危险因素(P<0.05)，吻合方式是减少胃排空障碍的保护因素(P<0.05)。

LPD术后PG较PJ对降低术后胰瘘、胃排空障碍更有优势，吻合方式及胰瘘与DGE的发生显著相关。

To investigate the gastric emptying disorder after laparoscopic pancreaticoduodenectomy by using pancreatic gastric or bowel anastomosis.

Retrospective analysis were performed in 60 cases who underwent laparoscopic pancreatoduodenectomy from Jan 2015 to March 2018. According to different digestive tract reconstruction methods, the patients were divided into PG group and PJ group. Statistical analysis were performed by using SPSS 21.0 software. Measurement data, such as perioperative indicators and nutrition status were expressed as (±s), and were examined by one-way variance analysis and t test. Count data such as postoperative complications and the incidence of gallbladder stones were examined by chi square test. Univariate / Multivariate analysis were used to explore the risk factors of gastric emptying disorder. A P value <0.05 was considered as statistically significant difference.

The operations were all successfully performed in both groups, with no conversion to laparotomy. In PG group, there were 6 cases (21.4%) of short-term complications and 1 case (3.6%) of long-term complications. In PJ group, there were 12 cases (37.5%) of short-term complications and 4 cases (12.5%) of long-term complications. The short-term and long-term complications in PG group were less than those in PJ group respectively (P<0.05) .There were 8 cases(13.3%) of gastric emptying after operation in 60 patients with PD, Univariate analysis showed that anastomosis method, postoperative bleeding and pancreatic fistula were the influencing factors of gastric emptying disorder (P<0.05). Multivariate analysis showed that pancreatic fistula was an independent risk factor for gastric emptying disorder (P<0.05), while anastomosis method was a protective factor for reducing gastric emptying disorder(P<0.05).

LPG after PD has more advantages than PJ in reducing postoperative pancreatic fistula and gastric emptying disorder. The anastomosis method and postoperative pancreatic fistula were significantly correlated with the occurrence of DGE.