改良套人式胰肠端端吻合对胰十二指肠切除术后胰瘘的影响

目的探讨改良套入式胰肠端端吻合对胰十二指肠切除术后胰瘘的影响。方法回顾性分析2001年1月至2011年1月山东省肿瘤医院施行396例胰十二指肠切除术患者的临床资料。根据吻合方式分为2组：改良组235例，经典组161例。两组患者均由同一术者带领的医疗小组完成手术，消化道重建以Child吻合为基本术式。改良组采用改良套入式胰肠端端吻合，经典组采用经典套入式胰肠端端吻合，两组患者在术中及术后的处理均相同。比较两组患者术中出血量、手术时间、术后胰瘘和住院时间。计量资料采用t检验，计数资料采用∥检验，胰瘘的分析采用Fisher确切概率法。结果改良组和经典组患者术中平均出血量、平均手术时间、平均住院时间分别为（383±56）ml、（7．2±1．0）h、（21±3）d和（3814-39）ml、（7．0±0．5）h、（22±5）d，两组比较，差异无统计学意义（t=0．388，1．680，一1．835，P〉0．05）。396例患者均无手术死亡发生，胰瘘总发生率为7．6％（30／396）。改良组患者术后无一例胰瘘发生，经典组患者术后发生胰瘘30例（胰肠吻合口瘘4例、单纯性胰瘘26例），两组比较，差异有统计学意义（P〈0．05）。经典组中发生胰瘘的患者通过保持引流通畅、使用生长抑素及胃肠外营养等保守治疗后痊愈。结论改良套入式胰肠端端吻合能显著降低胰十二指肠切除术后胰瘘的发生率。

Effects of improved end-to-end invagination pancreaticojejunostomy on the occurrence of pancreatic fistulaafter pancreaticoduodenectomy

Objective To investigate the effects of improved end-to-end invagination pancreaticojejunostomy on the occurrence of pancreatic fistula after pancreaticoduodenectomy. Methods The clinical data of 396 patients who received pancreaticoduodenectomy at the Cancer Hospital of Shandong Province from January 2001 to January 2011 were retrospectively analyzed. All patients were divided into the improved group （235 patients） and tradi- tional group （161 patients） according to different anastomotic methods. All tile operations were done by the same surgical group, and the digestive tract was reconstructed by the Child method. Patients in the improved group received improved end-to-end invagination pancreaticojejunostomy, and patients in the traditional group received traditional end-to-end anastomosis. The volume of operative bleeding, operation time, incidence of pancreatic fistula and duration of hospital stay of the 2 groups were compared. All data were analyzed using the t test, chi- square test or Fisher exact probability. Results The operative blood loss, operation time and duration of hospital stay were （383 ±56）ml, （7.2 ± 1.0）hours, （21±3）days in the improved group, and （381±39）ml, （7.0 ± 0.5） hours, （22 ± 5 ）days in the traditional group, with no significant difference between the 2 groups （t = 0. 388, 1. 680, - 1. 835, P 〉 0.05 ）. No operative death was detected in the 2 groups, and the overall incidence of pancreatic fistula was 7.6% （30/396）. The incidence of pancreatic fistula of the improved group was 0 （0/235）, which was significantly lower than 18.6% （30/161） of the traditional group （ P 〈 0.05 ）. Patients complicated with pancreatic fistula in the traditional group were cured by drainage, somatostatin administration and parenteral nutrition. Conclusion hnproved end-to-end invagination pancreaticojejunostomy can significantly reduce the incidence of pancreatic fistula after pancreaticoduodenectomy.