改良胰肠荷包套入式吻合方式的临床应用

摘要

目的 探讨改良胰腺空肠端侧荷包套入式吻合方式在消化道重建中的应用价值.方法 回顾性分析2016年4月至2017年3月河北省沧州市中心医院收治的37例胰十二指肠切除术患者行改良胰腺空肠荷包套入式吻合术的临床资料.观察术中胰肠吻合时间、术中出血量,检测术后第3、5、7天胰肠吻合口周围引流物淀粉酶浓度.术后患者每3个月复查上腹部增强CT,随访1年,随访截止时间2017年7月.结果 所有患者均顺利完成手术.胰肠吻合时间(11±3)min,术中出血量(465±161)mL,术后第3、5、7天胰肠吻合口周围引流物淀粉酶浓度[M(Q)]分别为18.0(64.5)U、16.0(112.2)U、7.0(19.5)U,引流液淀粉酶呈逐渐减少趋势(F=18.104,P<0.05).术后并发症:生化漏1例;腹腔内出血1例,再次剖腹探查发现为空肠切开处黏膜出血.36例患者获得随访,无胰管结石及急慢性胰腺炎,无腹泻等胰腺外分泌功能不足的表现.结论 改良胰腺空肠荷包套入式吻合方式操作简便、省时、可靠,在胰十二指肠切除术中具有临床应用价值.%Objective To investigate the clinical value of modified pouch-encasing type of pancreatico-jejunostomy in digestive tract reconstruction. Methods The clinical data of 37 patients who received modified pouch-encasing type of pancreaticojejunostomy in Cangzhou Central Hospital from Apr. 2016 to Mar. 2017 were retrospectively analyzed. All patients underwent pancreaticoduodenectomy that adopted modified pouch-encasing type of pancreaticojejunostomy. The intraoperative situation and amylase concentration of drainage at postoperative day 3, 5, 7 were observed and monitored. The patients were followed up for upper abdominal enhanced CT every 3 months until Jul. 2017. Results All the 37 patients underwent the surgery successfully. The duration of pancreaticojejunostomy were (11±3) min. The volume of intraoperative blood loss was (465±161) mL. The amylase concentrations of drainage at postoperative day 3, 5, 7 were 18.0 (64.5) U, 16.0 (112.2) U, 7.0 (19.5) U, and the concentration decreased with the time (F=18.104, P<0.05). There was 1 patients with biochemical leak and 1 with intra-abdominal hemorrhage; 36 patients were followed up, showed no pancreatolithiasis, acute or chronic pancreatitis, or symptom of pancreatic exocrine insufficiency. Conclusion Modified pouch-encasing type of pancreaticojejunostomy is easy to master, and is time-saving and reliable, which has better clinical efficacy after pancreaticoduodenectomy.