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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (04) : 396 -399. doi: 10.3877/cma.j.issn.1674-3946.2021.04.012

论著

胰十二指肠切除术中两种胰肠吻合方式的临床对比研究
李海寿1, 尹林1, 黄子健1, 韦合雷1, 莫毓1,†()   
  1. 1. 547000　广西省河池市，河池市人民医院普通外科
  • 收稿日期:2020-08-07 出版日期:2021-08-17
  • 通信作者: 莫毓

Comparative study on clinical effects of two kinds of pancreaticojejunostomy in pancreaticoduodenectomy

Haishou Li1, Lin Yin1, Zijian Huang1, Helei Wei1, Yu Mo1,†()   

  1. 1. General Surgery, Hechi People’s Hospital Hechi City, Guangxi Province 547000, China
  • Received:2020-08-07 Published:2021-08-17
  • Corresponding author: Yu Mo
  • Supported by:
    Guangxi Key Research and Development Plan(Guike AB17195003); Guangxi Medical and Health Appropriate Technology Development and Promotion Application Project(S201892-02); Project of Hechi Municipal Financial Fund Plan(Hekeneng 1378-1)
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李海寿, 尹林, 黄子健, 韦合雷, 莫毓. 胰十二指肠切除术中两种胰肠吻合方式的临床对比研究[J]. 中华普外科手术学杂志(电子版), 2021, 15(04): 396-399.

Haishou Li, Lin Yin, Zijian Huang, Helei Wei, Yu Mo. Comparative study on clinical effects of two kinds of pancreaticojejunostomy in pancreaticoduodenectomy[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(04): 396-399.

目的

研究两种不同的胰肠吻合方式在胰十二指肠切除(PD)术中的临床疗效。

方法

回顾性分析2017年1月至2019年12月行PD的85例患者临床资料。根据胰肠吻合方式不同分为两组，常规组47例行常规胰管空肠黏膜端侧吻合术，改良组38例行改良胰管-空肠黏膜端侧吻合术。使用统计学软件SPSS 24.0进行数据分析，围术期指标、淀粉酶浓度等计量资料采用(±s)表示，独立t检验；术后并发症等计数资料采用χ2检验。以P<0.05为差异有统计学意义。

结果

改良组术中出血量及腹腔引流管拔管时间均少于常规组(P<0.05)；改良组胰瘘的发生率为13.2%明显低于常规组的31.9%(P<0.05)，两组间胃排空延迟、胆漏、腹腔出血及腹腔感染的发生率差异无统计学意义(P>0.05)；改良组术后1 d、3 d及7 d的引流液淀粉酶浓度均低于常规组，其中第1 d及第3 d两组间差异有统计学意义(P<0.05)。

结论

改良胰管-空肠黏膜端侧吻合术安全有效，相较于传统吻合方式，能明显降低术后胰瘘的发生，值得临床推广。

关键词: 胰十二指肠切除术, 胰管空肠吻合术, 手术后并发症, 疗效比较研究
Objective

To study the clinical effects of two different pancreaticojejunostomy in pancreaticoduodenectomy(PD).

Method

The clinical data of 85 patients of PD from January 2017 to December 2019 were retrospectively analyzed. They were divided into two groups according to the different methods of pancreaticojejunostomy, 47 patients in the conventional group underwent conventional pancreaticojejunostomy and 38 patients in the modified group underwent modified pancreaticojejunostomy. Statistical software SPSS 24.0 was used for data analysis. perioperative indicators, amylase concentration and other measurement data were expressed as (±s), independent t test preformed; Postoperative complications were tested by χ2 test. P<0.05 was considered statistically significant.

Result

The intraoperative blood loss and extubation time of abdominal drainage tube in the improved group were less than those in the conventional group (P<0.05), The incidence of pancreatic fistula in the modified group(13.2%) was lower than that in the conventional group (31.9%) (P<0.05). There was no significant difference in the incidence of delayed gastric emptying, bile leakage, abdominal bleeding and abdominal infection between the two groups (P>0.05); The amylase concentration of drainage fluid in the improved group was lower than that in the conventional group at 1, 3 and 7 days after operation, and there was statistical significance between the two groups on the first and third days (P<0.05).

Conclusion

The modified pancreaticojejunostomy is safe and effective. Compared with the traditional anastomosis, it can significantly reduce the incidence of postoperative pancreatic fistula, which is worthy of clinical promotion.

Key words: Pancreaticoduodenectomy, Pancreaticojejunostomy, Postoperative complications, Comparative effectiveness research
表1 85例行PD患者不同胰肠吻合方式两组患者一般临床资料比较[(±s)，例]
组别 例 性别 年龄(岁) BMI (kg/m2) 病变部位
男/女 a/b/c/d
改良组 38 22/16 57.2±11.6 21.7±2.6 5/4/19/10
常规组 47 27/20 56.8±11.3 21.9±2.9 7/6/21/13
χ2/t - 0.001 0.160 0.330 0.274
P - 0.966 0.436 0.370 0.964
组别 例 术前总胆红素(mol/L) 术前白蛋白(g/L) 胰管直径(mm) 胰腺质地(硬/软)
改良组 38 105.8±11.4 35.4±7.1 3.9±1.9 31/7
常规组 47 107.1±12.1 36.2±7.0 4.0±2.0 40/7
χ2/t - 0.505 0.520 0.234 0.190
P - 0.307 0.302 0.407 0.662
表2 85例行PD患者不同胰肠吻合方式两组患者围术期指标比较(±s)
组别 例数 手术用时(min) 胰肠吻合用时(min) 术中出血量(ml)
改良组 38 432.9±76.4 26.3±7.5 366.9±42.2
常规组 47 412.6±78.1 22.8±7.2 389.4±45.1
t   1.203 2.187 2.353
P   0.116 0.015 0.010
组别 例数 拔管时间(d) 住院时间(d)
改良组 38 8.2±1.5 13.8±6.7
常规组 47 9.4±1.7 14.3±7.5
t   3.408 0.320
P   0.000 0.374
表3 85例行PD患者不同胰肠吻合方式两组患者术后并发症发生情况(例)
组别 例 胰瘘 胃排空延迟 胆漏 腹腔出血 腹腔感染
总数 分级
生化漏 B级 C级
改良组 38 5 3 2 0 2 1 1 2
常规组 47 15 7 5 3 4 2 2 3
χ2 - 4.108 2.194 0.249 0.989 0.024 0.035 0.035 0.060
P - 0.042 0.138 0.617 0.319 0.876 0.851 0.851 0.806
表4 85例行PD患者不同胰肠吻合方式两组患者术后引流液淀粉酶浓度比较[(±s), U/L]
组别 例 第1 d 第3 d 第7 d
改良组 38 46.1±5.2 31.1±4.3 6.3±1.2
常规组 47 48.5±5.6 32.9±4.5 6.7±1.1
t - 2.027 1.870 1.600
P - 0.028 0.032 0.056
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