摘要
目的对比胰体尾切除术(distal pancreatectomy,DP)中胰腺残端切闭联合手工缝合与胰腺-空肠端端吻合的疗效。方法回顾性分析2017年9月至2019年3月昆明医科大学第二附属医院肝胆胰外科三病区收治的64例行胰体尾切除术患者的临床资料。根据胰腺残端处理方式分为两组:残端闭合组:DP术中胰腺使用切割闭合器切闭后联合手工加强缝合(n=30);胰肠吻合组:DP术中胰腺残端与空肠端端套入式吻合(n=34)。观察指标包括两组的一般资料、胰腺质地、手术时间、术中出血量、术后胰瘘发生率、出血等并发症、总住院天数、费用。结果64例均手术成功。胰肠吻合组中术后发生胰瘘5例,且均为软胰腺患者;而残端闭合组术后发生胰瘘11例,其中软胰腺7例,硬胰腺4例;胰肠吻合组术后胰瘘发生率明显低于残端闭合组,差异有统计学意义(P<0.05);比较两组胰瘘分级、术中出血量、术后出血等并发症,差异无统计学意义(P>0.05);另对于两组手术时间、总住院时间、住院总费用的比较,胰肠吻合组均大于残端闭合组,差异有统计学意义(P<0.05)。结论DP术中胰腺残端使用胰肠-空肠端端吻合可有效降低术后胰瘘发生率,且对于胰腺质地硬者效果更佳,安全可行,值得推广。
Objective To compare the effectiveness between pancreatic stump closure combined with manual suture closure and end-to-end anastomosis of pancreas and jejunum during distal pancreatectomy(DP).Methods The clinical data of 64 patients who received DP from Sep.2017 to Mar.2019 in the Second Affiliated Hospital of Kunming Medical University were retrospectively analyzed.According to the methods of coping with pancreatic stump,the 64 patients were divided into two groups:staple and manual suture closure combining group(n=30)and pancreaticojejunostomy group(n=34).The observational indicators were as follows:general information,pancreas texture,operation time,intraoperative blood loss,postoperative complications such as pancreatic fistula and bleeding,total hospitalization time and expenses.Results DP was performed successfully in all the 64 patients.Pancreatic fistula occurred in 5 patients in pancreaticojejunostomy group,all of whom were soft pancreas patients;while it occurred in 11 patients in staple and manual suture closure combining group,of whom 7 were with soft pancreas and 4 with hard pancreas.The rate of pancreatic fistula in pancreaticojejunostomy group was lower than that in staple and manual suture closure combining group,with statistically significant difference(P<0.05).No significant difference was observed in pancreatic fistula classification,intraoperative blood loss or postoperative bleeding between the two groups(P>0.05).The operation time and total hospitalization time were longer,and the total expenses were higher in pancreaticojejunostomy group compared with those in staple and manual suture closure combining group.The difference had statistical significance(P<0.05).Conclusion Pancreaticojejunostomy during DP can effectively reduce the incidence of postoperative pancreatic fistula,and it is more effective,safe and feasible for those with hard pancreas.
作者
白锦峰
陈章彬
郭志唐
王斌
滕毅山
BAI Jin-feng;CHEN Zhang-bin;GUO Zhitang;WANG Bin;TENG Yi-shan(The Third Ward of Hepatobiliary and Pancreatic Surgery,the Second Affiliated Hospital of Kunming Medical University,Kunming 650101,China)
出处
《肝胆胰外科杂志》
CAS
2019年第11期667-670,共4页
Journal of Hepatopancreatobiliary Surgery
关键词
胰体尾切除术
胰肠吻合
胰腺残端闭合
distal pancreatectomy
pancreaticojejunostomy
pancreatic stump closure
