摘要
目的探讨腹腔镜胰十二指肠切除术(PD)不同胰胃吻合方式的治疗效果及术后发生胃排空障碍(DGE)的危险因素。方法回顾性分析2021年2~12月在复旦大学附属华山医院东院接受腹腔镜PD的156例患者临床资料,依据PD术中吻合方式不同分为胰肠吻合(PJ)组76例与胰胃吻合(PG)组80例,比较两组患者手术指标及术后并发症发生情况。根据术后DGE发生情况将患者分为实验组(术后发生DGE)29例与对照组(术后未发生DGE)127例,比较两组患者的一般资料,对差异具有统计学意义的指标进一步行多因素Logistic回归分析影响DGE发生的危险因素。结果PJ组与PG组患者的术中出血量、手术时间比较差异均无统计学意义(P>0.05);PG组患者的住院时间、拔管时间、进食固态食物时间分别为(11.62±1.87)d、(3.36±0.94)d、(7.13±1.24)d,明显短于PJ组的(10.29±1.16)d、(2.91±0.87)d、(6.03±0.85)d,差异均有统计学意义(P<0.05);PG组患者的术后并发症及DGE发生率分别为13.75%、12.50%,明显低于PJ组的35.53%、25.00%,差异均有统计学意义(P<0.05);实验组与对照组患者的性别、低血糖、饮酒史、手术时间、术中出血量、营养风险筛查简表得分比较差异均无统计学意义(P>0.05),而在年龄、吻合方式、术后并发症、术后白蛋白水平、汉密尔顿抑郁量表(HAMD)得分及糖尿病方面比较差异均有统计学意义(P<0.05);经多因素Logistic回归分析结果显示,年龄、低血糖、吻合方式、术后并发症、术后白蛋白水平、HAMD得分及糖尿病为影响术后DGE发生的危险因素(P<0.05)。结论在PD术中采用PG吻合能明显缩短患者住院时间,促进疾病恢复,减少术后并发症发生,同时年龄、吻合方式、术后并发症、术后白蛋白水平、HAMD得分及糖尿病均可影响术后DGE发生。
Objective To investigate the therapeutic effects of laparoscopic pancreaticoduodenectomy(PD)with different pancreaticogastrostomy methods,and to analyze the risk factors for postoperative delayed gastric emptying(DGE).Methods The clinical data of 156 patients who underwent laparoscopic PD in East Hospital of Huashan Hospital Affiliated to Fudan University between February 2021 and December 2021 were analyzed retrospectively.According to different anastomosis methods used in PD,the patients were divided into pancreaticojejunostomy(PJ)group(76 cases)and pancreatogastrostomy(PG)group(80 cases).The surgical indexes and the incidence of postoperative complications were compared between the two groups.According to the presence or absence of postoperative DGE,the patients were divided into experimental group(29 patients with DGE)and control group(127 patients without DGE).General data of the two groups were compared,and multivariate logistic regression analysis was conducted to identify the risk factors for DGE.Results There was no statistically significant difference in intraoperative blood loss or operation time between PJ group and PG group(P>0.05).The length of hospital stay,extubation time,and duration of solid food intake in PG group were(11.62±1.87)d,(3.36±0.94)d,and(7.13±1.24)d,significantly shorter than(10.29±1.16)d,(2.91±0.87)d,and(6.03±0.85)d in PJ group(P<0.05).The incidence of postoperative complications and DGE in the PG group was 13.75% and 12.50%,respectively,significantly lower than 35.53% and 25.00% in the PJ group(P<0.05).There was no significant difference between the experimental group and the control group in terms of gender,hypoglycemia,drinking history,operation time,intraoperative blood loss,and nutritional risk screening score(P>0.05),but there were significant differences in terms of age,anastomotic mode,postoperative complications,postoperative albumin level,Hamilton Depression Scale(HAMD)score,and diabetes(P<0.05).Multivariate logistic regression analysis showed that age,hypoglycemia,a
作者
陈颖
胡丹红
郑子越
CHEN Ying;HU Dan-hong;ZHENG Zi-yue(Department of Pancreatic Surgery,East Hospital of Huashan Hospital Affiliated to Fudan University,Shanghai 201206,CHINA;Department of Oncology,East Hospital of Huashan Hospital Affiliated to Fudan University,Shanghai 201206,CHINA;ICU,East Hospital of Huashan Hospital Affiliated to Fudan University,Shanghai 201206,CHINA)
出处
《海南医学》
CAS
2023年第17期2504-2508,共5页
Hainan Medical Journal
基金
复旦大学附属华山医院科研启动基金(编号:21Y11920701)。
关键词
腹腔镜
胰十二指肠切除术
胰胃吻合
疗效
胃排空障碍
危险因素
Laparoscope
Pancreaticoduodenectomy
Pancreaticogastrostomy
Curative effect
Delayed gastric emptying
Risk factor
