胰腺残端缝合方式预防胰腺远端切除术后胰漏的动物实验

目的]探讨不同胰腺残端缝合方式预防胰腺远端切除术后胰漏的效果。方法]将34只实验用猪随机分为研究组与对照组,每组17只。研究组:超声刀横断胰腺,用4-0 Prolene线间断缝合胰腺残端,主胰管单独结扎;对照组:超声刀横断胰腺,用4-0 Prolene线U形交锁缝合胰腺残端,主胰管单独结扎。观察2组术后的胰漏情况,并于术后8周将动物处死,将胰腺切除后行病理检查,观察胰腺残端愈合情况。结果]34只实验猪中除对照组3只麻醉意外死亡外,其余31只均顺利完成手术。1)并发症:2组胰漏总体发生率比较差异无统计学意义(P=0.263),研究组生化漏发生率明显高于对照组(P=0.022),但研究组的临床相关胰漏(B或C级)发生率明显低于对照组(P=0.041);2)尸检及病理组织学检查:对照组发生胰漏的胰腺残端可见胰腺组织缺血坏死,显微镜下可见坏死组织周围有大量中性粒细胞浸润。结论]与胰腺残端行U形交锁缝合相比,胰腺残端单纯间断缝合能明显降低胰腺切除术后临床相关胰漏发生率。

Effect of pancreatic stump suture on the prevention of pancreatic leakage in animal model of distal pancreatectomy

Objective]To investigate the effect of different pancreatic stump suture methods on preventing pancreatic leakage after distal pancreatectomy.Methods]Thirty-four pigs were randomly divided into two groups:the study group(n=17):the pancreas was transected by ultrasound knife,the remnant of pancreas was sutured by 4-0 Prolene suture intermittently,and the main pancreatic duct was ligated separately.The control group(n=17):the pancreas was transected by ultrasound knife,and the remnant of pancreas was sutured with 4-0 Prolene U-shaped interlocking suture,and the main pancreatic duct was ligated separately.The leakage of pancreas was observed in both groups after the operation.The animals were sacrificed 8 weeks after the operation,the remnant pancreas was removed for pathological examination to evaluate the healing of pancreas.Results]In the control group,3 pigs died of anesthesia accident,and the other 31 pigs successfully completed the operation.1)Complications:there was no significant difference in the overall incidence of pancreatic leakage between the two groups(P=0.263).The incidence of biochemical leakage in the study group was significantly higher than that in the control group(P=0.022).However,the incidence of clinically relevant pancreatic leakage(Grade B or C)in the study group was significantly lower than that in the control group(P=0.041).2)Autopsy and histopathological examination:pancreatic tissue necrosis was noted in the pancreatic stump of the control group,and a large number of neutrophils infiltration around the necrotic tissue was noted under the microscope.Conclusion]Compared with the U-shaped interlocking suture of the pancreatic stump,the interrupted suture of the pancreatic stump can significantly reduce the incidence of clinically relevant pancreatic leakage after pancreatectomy.