摘要
目的探讨腹腔镜胰十二指肠切除术中降落伞式双荷包胰管空肠吻合的手术方法及其临床效果。方法回顾性分析河北医科大学第二医院肝胆外科2016年1月至2018年6月采用降落伞式双荷包胰管空肠吻合行腹腔镜胰十二指肠切除术的31例患者资料。结果31例患者均实施完全腹腔镜胰十二指肠切除术,其中2D腹腔镜下实施5例,3D腹腔镜下实施26例。实施胰腺全系膜切除12例,包括2例联合门静脉-肠系膜上静脉节段切除重建。31例患者手术时间为(412.8±102.4)min,术中出血量(462.8±396.7)ml,患者术后住院时间(14.7±8.9)d。31例患者降落伞式双荷包胰管空肠吻合操作时间20.0~45.0(29.7±6.8)min。8例(25.8%)患者术后出现了并发症,其中3例并发2种以上并发症。术后并发B/C级胰瘘2例(6.5%),胆瘘4例(12.9%)、胃排空障碍3例(9.7%)、门静脉血栓1例(3.2%)、并发腹腔积液1例(3.2%),消化道出血致患者围手术期死亡1例。结论腹腔镜胰十二指肠切除术降落伞式双荷包胰管空肠吻合发挥了腹腔镜的视角及操作优势,具有操作简便、容易掌握、安全可靠的优点,值得临床进一步研究及推广。
Objective To introduce the detailed surgical procedure of parachute-like-suture double-pouch pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy (LPD), and to study its clinical results. Methods A retrospective study was conducted on 31 patients who underwent parachute-like-suture double-pouch pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy between January 2016 and June 2018 in our department. Results Of 31 patients who underwent total laparoscopic pancreaticoduodenectomy, 5 patients underwent two-dimensional (2D) LPD and 26 underwent three-dimensional (3D) LPD. Total mesopancreas excision (TMpE) was performed in 12 patients, including 2 patients combined with PV-SMV segmental resection and reconstruction. The mean operative duration, and mean estimated blood loss, post-operative hospital stay were 412.8±102.4 min, 462.8±396.7 ml, 14.7±8.9 d, respectively. The operating time of parachute-like-suture double-pouch pancreaticojejunostomy was 29.7±6.8 min (20~45 min). Post-operative complications occurred in 8 patients (25.8%), 3 of whom suffered from more than two types of complications. There were 2 patients (6.5%) with postoperative B/C grade pancreatic fistula, 4 patients with postoperative biliary leakage (12.9%), 3 patients with delayed gastric emptying (9.7%), 1 patient with portal vein thrombosis (3.2%) and 1 patient with peritoneal effusion (3.2%). One patient died during perioperative period due to gastrointestinal hemorrhage. Conclusions Parachute-like-suture double-pouch pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy was a simple, convenient, reliable method. It is worthy of clinical promotion and further studied.
作者
张建生
李冬瑞
刘建华
邢中强
王天阳
杜成旭
路文彦
Zhang Jiansheng;Li Dongrui;Liu Jianhua;Xing Zhongqiang;Wang Tianyang;Du Chengxu;Lu Wenyan(Department of Hepatobiliary Surgery,the Second Hospital of Hebei Medical University,Shijiazhuang 050017,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2019年第6期431-434,共4页
Chinese Journal of Hepatobiliary Surgery
基金
河北省科技计划项目(17277783D).
关键词
胰十二指肠切除术
腹腔镜
双荷包胰管空肠吻合
降落伞式缝合
胰瘘
Pancreaticoduodenectomy
Laparoscopes
Double-pouch pancreaticojejunostomy
Parachute-like suture
Pancreatic fistula
