改良胰腺空肠套入式吻合在胰十二指肠切除术中的应用

摘要

Objective:To compare the pancreatic fistula rates of modified end-to-end invaginated pancreaticojejunostomy and duct-to-mucosa pancreaticojejunostomy applied in pancreaticoduodenectomy,and evaluate the application value of modified end-to-end invaginated pancreaticojejunostomy.Methods:The clinical data of 59 cases who received pancreaticoduodenectomy in our department from Jan.2014 to Dec.2016 were retrospectively analyzed.In all patients,35 cases underwent modified end-to-end invaginated pancreaticojejunostomy and 24 cases underwent duct-to-mucosa pancreaticojejunostomy.The pancreatic fistula rates and the other postoperative complications were compared.Results:There were no significant differences in operative time and intraoperative blood loss between two groups.No significant differences were noted in length of stay,mortality rate,postoperative complication rate,such as pancreatic fistula.Conclusion:The modified end-to-end invaginated pancreaticojejunostomy is also safe and reliable compared with duct-to-mucosa pancreaticojejunostomy.It has the advantages of easier performance,firm anastomose reliably,especially for patients with pancreatic duct diameter <3 mm,so it is recommended in clinical practice.%目的:比较在胰十二指肠切除术(PD)中,改良胰腺空肠套入式吻合与胰管空肠黏膜吻合两种胰肠吻合方式术后胰瘘等相关并发症的发生率.方法:回顾性分析2014年1月至2016年12月盛京医院胰腺内分泌外科实施的59例PD手术患者的临床资料,其中采用改良胰腺空肠套入式吻合35例,采用胰管空肠黏膜吻合24例,比较两组术后胰瘘等相关并发症的发生率.结果:比较改良胰腺空肠套入式吻合与胰管空肠黏膜吻合两种胰肠吻合方式,发现手术时间和术中出血比较无统计学差异;术后胰瘘等相关并发症指标、住院时间、死亡率等无统计学差异.结论:改良胰腺空肠套入式吻合与胰管空肠黏膜吻合相比,同样安全可靠,具有操作方便,易于掌握,胰肠吻合严密牢固的优点,尤其适用于胰管直径小的病人,值得临床应用.