胰十二指肠切除术后不同胰肠吻合方式的效果与评价

目的比较胰十二指肠切除术后三种不同胰肠吻合方式的胰肠吻合口瘘发生率,探讨实施不同吻合方式的适用条件及其合理性。方法回顾性分析92例胰十二指肠切除术患者的临床资料。按吻合方式不同分为捆绑式胰肠吻合组(A组)、胰管对空肠粘膜端侧吻合组(B组)和套入式端侧吻合组(C组),观察其术后胰瘘的发生率。结果胰肠吻合口瘘的发生率为:A组1例(1/41,2.44%);B组无胰肠吻合口瘘发生;C组3例(3/19,15.79%)。A、B两组间胰肠吻合口瘘发生率无统计学差异(P>0.05);C组胰肠吻合口瘘发生率显著高于A、B两组,差异有统计学意义(P<0.05)。结论胰管对空肠粘膜吻合法和捆绑式吻合法均为较安全的胰肠吻合方法。在条件许可下,胰管对粘膜吻合法应作为胰十二指肠切除术首选的胰肠吻合方法。

Effect and appraisals of three different pancreaticojejunostomy after pancreaticoduodenectomy

Objective To explore suitable and reasonable pancreaticojejunostomy using three different techniques after pancreaticoduodenectomy(PD).Method Data of 92 patients who underwent PD using binding pancreaticojejunostomy(group A),duct-to-mucosa pancreaticojejunostomy(group B) and end-to-side invagination pancreaticojejunostomy(group C) was retrospectively analyzed.Result The rate of pancreatic leakage was 2.44%,0% and 15.79% in group A,group B and group C respectively.The rate of pancreatic leakage in group C is higher than group A and group B(P<0.05),but no significant difference was observed between group A and group B(P>0.05).Conclusion Both binding pancreaticojejunostomy and duct-to-mucosa pancreaticojejunostomy are safety methods in PD.Duct-to-mucosa pancreaticojejunostomy can be the best choice owing to its less obstruction of pancreatic duct after PD.