胰腺-空肠套入式吻合与胰管-空肠黏膜吻合对胰十二指肠切除术术后并发症发生情况的影响

目的 探讨胰腺-空肠套入式吻合与胰管-空肠黏膜吻合对胰十二指肠切除术(PD)术后并发症发生情况的影响,为临床PD吻合方式的选择提供参考。方法 将接受PD治疗的60例患者随机化为胰腺-空肠组与胰管-黏膜组,每组各30例,两组患者手术均由同一医生操作,胰腺-空肠组于术中行胰腺-空肠套入式吻合,胰管-黏膜组于术中行胰管-空肠黏膜吻合。考察两组患者术后的并发症发生情况。结果 胰腺-空肠组死亡2例,病死率为6.67%,胰管-黏膜组死亡1例,病死率为3.33%,组间比较差异无统计学意义(P>0.05);除胰瘘(POPF)外,胰腺-空肠组的的术后并发症发生率为43.33%,胰管-黏膜组为40.00%,组间比较差异无统计学意义(P>0.05);但胰腺-空肠组的并发症严重程度高于胰管-黏膜组,III级以上并发症发生率组间比较差异有统计学意义(P<0.05);胰腺-空肠组的的术后POPF的发生率为30.00%,胰管-黏膜组为26.67%,组间比较差异无统计学意义(P>0.05),但胰管-黏膜组POPF的严重程度低于胰腺-空肠组(P<0.05);logistics回归分析发现,POPF与性别、胰管直径以及病理类型具相关性(P<0.05)。结论 除胰管较细患者建议行胰腺-空肠套入式吻合外,胰管-空肠黏膜吻合在PD手术中可最大程度降低PD术后并发症。

The effect of anastomosis of pancreas and jejunum in the anastomosis of pancreatic duct and jejunum mucosa on postoperative complications after PD

Objective To investigate the effect of the anastomosis between the pancreatic and jejunum anastomosis and the anastomosis of the pancreatic duct jejunum mucosa to the postoperative complications after PD.Methods 60 patients with PD were randomly divided into pancreatic duct and pancreatic duct mucosa group, 30 cases in each group, two groups of patients with PD were operated by the same doctor.To investigate the postoperative complications of the two groups of patients.Results Mortality rate was 2, mortality rate was 6.67%, mortality rate was 1, mortality rate was 40% in pancreatic duct and mucosa group, mortality was 3.33%, the incidence rate was 43.33%.The complication rate was significantly higher than that of pancreatic duct mucosa group (P>0.05).The incidence rate was 30%.POPF level was significantly higher than that of pancreatic duct and mucosa.The incidence rate was 26.67%.Logistics regression analysis showed that POPF was significantly associated with sex, pancreatic duct diameter and pathological type.Correlation (P<0.05).Conclusion The routine postoperative complications and POPF were similar in the PD operation, but the level was significantly increased by III and POPF, and the other cases were selected to be in the same way as the other cases.The results showed that the best method was to reduce the risk after PD.