胰腺远端切除术后残端不同处理方法对术后胰瘘的影响

[摘要]目的探讨胰腺远端切除术中，胰腺残端不同处理方法与术后胰瘘的关系。方法回顾性分析我院2009年3月至2012年12月期间，行胰腺远端切除术的患者临床资料46例，其中胰腺残端行连续锁边缝合10例（A组）；残端行主胰管结扎＋连续鱼嘴状缝合16例（B组）；残端断面局部行“8”字缝合＋连续鱼嘴状缝合20例（C组）。比较上述3种方式对术后并发胰瘘的影响并行统计学分析。结果术后发生胰瘘病例数，A组6例（60％），B组2例（12．5％），C组3例（15％）。其中，A组与B组、A组与C组比较有统计学差异（P〈0．05）；B组和C组比较无统计学差异（P〉0．05）。结论胰腺远端切除术中，胰腺残端行主胰管结扎＋连续鱼嘴状缝合，或者行残端断面局部“8”字缝合＋鱼嘴状连续缝合，是防止术后胰瘘安全有效的方法。

Influence of Closure Techniques for the Pancreatic Stump on Pancreatic Fistula after Distal Pancreatectomy

Objective To study the influence of closure techniques for the pancreatic stump on pancreat- ic fistula（PF） after distal pancreatectomy. Methods The data of 46 patients who had undergone distal pan- createctomy between March 2009 and December 2012 were reviewed retrospectively. The incidences of PF a- mong patients with continuous suture catcher with 4-0 prolene（ Group A） and patients with continuous fish- mouth- like suture with duct ligation（Group B） or ＂8＂ suture（Group C） were compared. Results The inci- dence of PF was 60% （6/10） in Group A,12.5% （2/16） in Group B and 15% （3/20） in Group C. There was a statistically significant difference between Group A and the other two groups. No significant difference was found between Group B and Group C. Conclusion Continuous fish-mouth-like suture with duct ligation or with ＂8＂ suture for the pancreatic stump near the pancreatic duct would reduce the fistula formation rate after distal pancreatectomy.