胰十二指肠切除术中两种胰肠吻合方式疗效比较

目的 比较胰十二指肠切除术中采用胰肠套入吻合与胰管-空肠黏膜对黏膜吻合术后胰漏发生率、住院时间和费用的差异。方法 回顾2009年3月至2013年5月126例接受胰十二指肠切除术治疗病例，采用胰肠套入吻合67例，胰管-空肠黏膜对黏膜吻合59例。分析两种胰肠重建方式术后胰漏发生率及严重程度的差异，同时对两组平均住院时间及费用进行比较分析。结果 套入式胰肠重建组术后胰漏发生率为31.34%（21/67），黏膜对黏膜胰肠重建组为13.56%（8/59）；两组术后胰漏严重程度（A、B、C级）情况分别为10.45%（7/67），14.93%（10/67），5.97%（4/67）和8.47%（5/59），3.39%（2/59），1.69%（1/59）。两组平均住院时间为（24.15 d vs 16.86 d），费用分别为（49 882.73元 vs 38 047.80元）。两组患者术后胰漏发生率和严重程度B级所占比例、平均住院时间和费用差异均有统计学意义（P均＜0.05）。结论 采用胰管-空肠黏膜对黏膜吻合的胰肠重建方式术后胰漏发生率和严重程度（B级）、平均住院时间和费用明显低于采用胰肠套入吻合，该法可能更有利于患者术后恢复。

Comparison of the efficacy of two styles of pancreaticojejunostomy in pancreaticoduodenectomy

Objective To compare the effects of side-to-end or end-to-end pancreaticojejunostomy and duct-to-mucosa pancreaticojejunostomy in pancreaticoduodenectomy on the postoperative pancreatic fistula, the hos- pitalization days and the medical expense. Methods The clinical data of 126 patients who underwent pancreaticoduodenectomy from Mar. 2009 to May 2013 were retrospectively analyzed. Side-to-end or end-to- end pancreaticojejunostomy were used in 67 cases and duct-to-mucosa pancreaticojejunostomy were used in 59 cases. The incidence and severity of postoperative pancreatic fistula, the hospitalization days and the medical expense were compared between the two groups. Results The incidence of postoperative pancreatic fistula was 31.34% （21/67） in the side-to-end or end-to-end group significant difference between the two groups （P〈0.05）. B, C） were respectively 10.45% （7/67）, 14.93% （10/67）, and 13.56% （8/59） in the duct-to-mucosa group, with a The severity of postoperative pancreatic fistula （rank-A, 5.97% （4/67） and 8.47% （5/59）, 3.39% （2/59）, 1.69% （I/ 59）, with a significant difference between the two groups in rank-B （P〈0.05）. The average hospitalization duration and medical expense were 16.86 d and 38 047.80 Yuan in the duct-to-mucosa group, which were significantly lower than 24.14 d and 49 882.73 Yuan in the side-to-end or end-to-end group （P〈0.05）. Conclu- sion Compared with side-to-end or end-to-end pancreaticojejunostomy, duct-to-mucosa pancreaticojejunostomy is a better style with a lower incidence and severity （rank-B） of postoperative pancreatic fistula, a shorter hospitalization duration and less medical expense. The duct-to-mucosa pancreaticojejunostomy may be better for postoperative recovery of patients.