改良套入式胰肠吻合技术在胰十二指肠切除术中的临床应用研究

目的探究改良套入式胰肠吻合技术在胰十二指肠切除术中应用的安全性与可靠性。方法 2014年至2016年对33例接受胰十二指肠根治术的患者进行前瞻性研究,术中胰肠吻合采用改良套入式胰肠吻合技术。并记录其一般情况及术后胰瘘、胆瘘、延迟胃排空、切口延迟愈合、感染等并发症情况。数据分析用SPSS 19统计软件,根据数据变量类型以±s或X0.5(Q25,Q 75)表示,选择卡方检验(Chi-square test)计算不同胰腺质地与胰瘘关系。并根据统计学结果以Graphpad prism 5行统计图绘制。P0.05认为差异有统计学意义。结果总体并发症率为24.2%(8/33),胰瘘发生率为15.2%(5/33),A级胰瘘占总体胰瘘率的80.0%(4/5)。其中质软胰腺与质硬胰腺胰瘘发生概率差异无统计学意义(χ2=0.05,P=0.934)。胆瘘发生率3.0%(1/33),出血发生率6.1%(2/33),延迟胃排空发生率为3.0%(1/33),围手术期无二次手术及死亡病例。结论应用改良套入式胰肠吻合技术胰瘘发生概率较低,手术安全可靠,操作简便。

A prospective study of modified invagination for pancreatojejunostomy after pancreaticojejunostomy

Objective To investigate the safety and reliability of the modified invagination for pancreatojejunostomy.Methods Prospective study of 33 patients who underwent PD with modified invagination for pancreatojejunostomy from 2014 to 2016.The general situation and postoperative complications such as pancreatic fistula,biliary fistula,delayed gastric emptying,delayed wound healing and infection were recorded.Satatistical analysis were performed by using SPSS 19 software.Measurement data such as perioperative indicators were expressed as mean±standard deviation(x-±s)or X0.5(Q25,Q75),and were examined by using t test.Chi-square test was used to calculate the relationship between pancreatic texture and pancreatic fistula.Graphpad prism 5 was used to draw statistical Graph.A P value <0.05 was considered as statistically significant difference.Result The overall complication rate was 24.2％(8/33),and pancreatic fistula rate of was 15.2％(5/33).Pancreatic fistula of Grade A accounted for 4/5(80.0％).The soft and hard pancreas pancreatic fistula rate had no significant difference(x2=0.05,P=0.934).The incidence of biliary fistula rate was 3.0％(1/33),and hemorrhage rate was 6.1％(1/33).The incidence of delayed gastric emptying was 3.0％(1/33).No perioperative reoperation and death were observed.Conclusion It is safe and reliable to use the modified invagination for pancreatojejunostomy in PD.