切换至 "中华医学电子期刊资源库"
高级检索
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)
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

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/OL]. 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/OL]. 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
[1]
Katz MG, Fenton SJ, Russell KW, et al. Surgical outcomes of pancreaticoduodenal injuries in children[J]. Pediatr Surg Int, 2018, 34(6): 641-645.
[2]
Xiong J, Szatmary P, Huang W, et al. Enhanced Recovery After Surgery Program in Patients Undergoing Pancreaticoduodenectomy: A PRISMA-Compliant Systematic Review and Meta-Analysis[J]. Medicine(Baltimore), 2016, 95(18): e3497.
[3]
Andrianello S, Pea A, Pulvirenti A, et al.Pancreaticojejunostomy after pancreaticoduodenectomy: Suture material and incidence of post-operative pancreatic fistula[J]．Pancreatology, 2016, 16(1): 138-141.
[4]
Nassour I, Wang SC, Christie A, et al. Minimally Invasive Versus Open Pancreaticoduodenectomy: A Propensity-matched Study From a National Cohort of Patients[J]. Ann Surg, 2018, 268(1): 151-157.
[5]
Hua J, He Z, Qian D, et al. Duct-to-Mucosa Versus Invagination Pancreaticojejunostomy Following Pancreaticoduodenectomy: a Systematic Review and Meta-Analysis[J]. J Gastrointest Surg, 2015, 19(10): 1900-1909.
[6]
中华医学会外科学分会胰腺外科学组，中国医疗保健国际交流促进会胰腺病分会胰腺微创治疗学组，中国研究型医院学会胰腺疾病专业委员会胰腺微创学组，等. 腹腔镜胰十二指肠切除手术专家共识(附：手术流程与主要步骤)[J]. 中华外科杂志，2017，55(5)：335-339.
[7]
Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After[J]．Surgery, 2017, 161(3): 584-591.
[8]
WangJ, Ma R, Churilov L, et al. The cost of perioperative complications following pancreaticoduodenectomy: A systematic review[J]. Pancreatology, 2018, 18(2): 208-220.
[9]
Peng L, Lin S, Li Y, et al. Systematic review and meta-analysis ofrobotic versus open pancreaticoduodenectomy[J]. Surg Endosc, 2017, 31(8): 3085-3097.
[10]
吴耐，张蓬波，任泽强. 胰十二指肠切除术后胰瘘发生的危险因素及风险预测[J]. 中国普外基础与临床杂志，2018，25(7)：889-894.
[11]
Pedrazzoli S. Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF): A systematic review and analysis of the POPF-related mortality rate in 60, 739 patients retrieved from the English literature published between 1990 and 2015[J]. Medicine(Baltimore), 2017, 96(19): e6858.
[12]
Liu R, Zhang T, Zhao Z-M, et al. The surgical outcomes of robot-assisted laparoscopic pancreaticoduodenectomy versus laparoscopic pancreaticoduodenectomy for periampullary neoplasms: a comparative study of a single center[J]. Surg Endosc, 2017, 31(6): 2380-2386.
[13]
张伟，温馨，曹宽，等. 胰十二指肠切除术后胰瘘的影响因素及胰瘘风险评分系统对其术后主胰管引流方式选择的价值[J]. 中国普外基础与临床杂志，2019，26(1)：42-48.
[14]
Shrikhande SV, Sivasanker M, Vollmer CM, et al. Pancreatic anastomosis after pancreatoduodenectomy: A position statement by the International Study Group of Pancreatic Surgery (ISGPS)[J]. Surgery, 2017, 161(5): 1221-1234.
[15]
Varco RL. A method of implanting the pancreatic duct into the jejunum in the Whipple operation for carcinoma of the pancreas；case report[J]. Surgery, 1945, 18: 569-573.
[16]
Bai X, Zhang Q, Gao S, et al. Duct-to-Mucosa vs Invagination for Pancreaticojejunostomy after Pancreaticoduodenectomy: A Prospective, Randomized Controlled Trial from a Single Surgeon[J]. J Am Coll Surg, 2016, 222(1): 10-18.
[17]
罗耀兵，徐小立. 改良胰管空肠黏膜端侧吻合胰十二指肠切除术临床效果研究[J/CD]. 中华普外科手术学杂志(电子版)，2020，14(3)：264-267.
[1] 马桥桥, 张传开, 郭开今, 蒋涛, 王子豪, 刘勇, 郝亮. 可降解止血粉减少初次全膝关节置换术失血量的研究[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 585-589.
[2] 冷建军, 朴成林, 司振铎. 胰十二指肠切除术联合小范围肝切除、血管切除重建[J/OL]. 中华普通外科学文献(电子版), 2024, 18(05): 384-384.
[3] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[4] 刘世君, 马杰, 师鲁静. 胃癌完整系膜切除术+标准D2根治术治疗进展期胃癌的近中期随访研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 27-30.
[5] 李华志, 曹广, 刘殿刚, 张雅静. 不同入路下行肝切除术治疗原发性肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 52-55.
[6] 常小伟, 蔡瑜, 赵志勇, 张伟. 高强度聚焦超声消融术联合肝动脉化疗栓塞术治疗原发性肝细胞癌的效果及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 56-59.
[7] 王露, 周丽君. 全腹腔镜下远端胃大部切除不同吻合方式对胃癌患者胃功能恢复、并发症发生率的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 92-95.
[8] 许杰, 李亚俊, 冯义文. SOX新辅助化疗后腹腔镜胃癌D2根治术与常规根治术治疗进展期胃癌的近期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 647-650.
[9] 康婵娟, 张海涛, 翟静洁. 胰管支架置入术治疗急性胆源性胰腺炎的效果及对患者肝功能、炎症因子水平的影响[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 667-670.
[10] 张超, 张珍, 马梁, 穆欢欢, 刘彩玲. 腹腔镜胰十二指肠切除术术后C级胰瘘患者临床特征及影响因素研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 675-678.
[11] 付成旺, 杨大刚, 王榕, 李福堂. 营养与炎症指标在可切除胰腺癌中的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 704-708.
[12] 曾繁利, 齐秩凯, 杨贺庆. 两种经Glisson蒂鞘解剖路径肝切除术治疗原发性肝癌的肿瘤学疗效及风险比对[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 525-527.
[13] 王维花, 王楠, 乔庆, 罗红. 完全腹腔镜右半结肠癌切除术两种腔内消化道重建方案对比研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 574-577.
[14] 罗柳平, 吴萌萌, 陈欣磊, 林科灿. 胰腺全系膜切除在胰头癌根治术中的应用价值[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 651-656.
[15] 韩青雷, 丛赟, 李佳隆, 邵英梅. 术前减黄方式对壶腹周围癌胰十二指肠切除术后并发症的影响[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 665-669.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号