胰十二指肠切除术中胰肠吻合方式与术后胰漏及吻合口出血的相关性研究

目的分析胰十二指肠切除术（PD）中胰肠吻合方式与术后胰漏及吻合口出血的关系。方法回顾性分析2008年1月至2012年9月期间我院行PD的526例患者的临床资料。526例PD患者行胰肠吻合的方式：胰管空肠端侧黏膜对黏膜吻合（简称黏膜对黏膜吻合）359例,其中149例硅胶引流管内置（简称引流管内置）,130例硅胶引流管引流至体外（简称引流至体外）,80例硅胶引流管未放置（简称引流管未置）;胰腺空肠端侧套入式吻合165例（简称套入式吻合）,均未放置硅胶引流管;胰肠侧侧吻合2例（简称侧侧吻合）,均未放置硅胶引流管。结果526例PD患者术后共发生胰漏34例（6.46%）,胰肠吻合口出血8例（1.52%）,死亡32例（6.08%）。①黏膜对黏膜吻合的胰漏发生率明显低于套入式吻合〔4.18%（15/359）比11.52%（19/165）,χ2=10.029,P=0.002〕;黏膜对黏膜吻合与套入式吻合的吻合口出血发生率比较差异无统计学意义〔1.67%（6/359）比1.21%（2/165）,χ2=0.159,P=0.691〕。②黏膜对黏膜吻合术式中,引流管内置者和引流至体外者的胰漏发生率均分别明显低于引流管未置者〔2.68%（4/149）比11.25%（9/80）,χ2=7.132,P=0.008;1.54%（2/130）比11.25%（9/80）,χ2=9.410,P=0.002〕;引流管内置者与引流至体外者的胰漏发生率比较差异无统计学意义〔2.68%（4/149）比1.54%（2/130）,χ2=0.433,P=0.510〕。引流管内置者与引流至体外者的吻合口出血发生率比较差异无统计学意义〔2.68%（4/149）比1.54%（2/130）,χ2=0.433,P=0.510〕。结论黏膜对黏膜吻合方式胰漏的发生率明显低于套入式吻合方式,但吻合口出血的发生率无明显差异。胰管内硅胶引流管内置或引流至体外均能降低术后胰漏的发生率,但是对于吻合口出血的发生率无明显影响。

Correlation Study of Pancreatic Leakage and Anastomotic Bleeding in Pancreaticojejunostomy after Pancreaticoduodenectomy

Objective To analyze the difference in the incidence of postoperative pancreatic leakage and anastomotic bleeding complications in various methods of pancreaticojejunostomy after pancreaticoduodenectomy（PD）.Methods The clinical data of 526 patients underwent pancreaticojejunostomy from January 2008 to September 2012 in this hospital were analyzed retrospectively.End-to-side ＂pancreatic duct to jejunum mucosa-to-mucosa＂ anastomosis（abbreviation：mucosa-to-mucosa anastomosis） was performed in 359 patients,which contained 149 patients with internal drainage,130 patients with external drainage,and 80 patients with no drainage.End-to-side invaginated anastomosis was performed in 165 patients without drainage.In addition,side-to-side anastomosis was performed in 2 patients without drainage. Results There were 34 cases（6.46%） of pancreatic leakage,8 cases（1.52%） of anastomotic bleeding in pancreaticojejunostomy,and 32 cases of death（6.08%）.① The pancreatic leakage rate of mucosa-to-mucosa anastomosis was significantly lower than that of end-to-side invaginated anastomosis ？（4.18%（15/359） versus 11.52%（19/165）,χ2=10.029,P=0.002）.There was no significant difference of the anastomotic bleeding incidence between mucosa-to-mucosa anastomosis and end-to-side invaginated anastomosis ？（1.67%（6/359） versus 1.21%（2/165）,χ2=0.159,P=0.691）.② In the mucosa-to-mucosa anastomosis group,the pancreatic leakage rates in the ones with internal drainage and external drainage were lower than those in the ones without drainage,respectively（2.68%（4/149） versus 11.25%（9/80）,χ2=7.132,P= 0.008;1.54%（2/130） versus 11.25%（9/80）,χ2=9.410,P=0.002）;which was no significant difference between the ones with internal drainage and external drainage？（2.68%（4/149） versus 1.54%（2/130）,χ2=0.433,P=0.510）？.But there were no significant differences for both the pancreatic leakage（2.68%（4/149） versus 1.54%（2/130）,χ2=0.433,P=0.510） and anastomotic bleeding incidence？（2.68%（4/149） versus 1.54%（2/130）,χ2=0.433,P=0.510） between the ones with internal drainage and external drainage.Conclusions Mucosa-to-mucosa anastomosis has a lower pancreatic leakage incidence as compared with end-to-side invaginated anastomosis.However,there is no significant difference of the anastomotic bleeding incidence.Internal or external drainage could reduce the incidence of pancreatic leakage,but have no obvious effect to the anastomotic bleeding incidence.