一种简易胰肠套入捆绑式吻合术式的临床应用观察

目的 探讨胰十二指肠切除术简易的胰肠套入捆绑式吻合方法的临床应用价值.方法 回顾性分析2003年5月至2013年5月在我院行胰十二指肠切除术56例患者的临床资料,其中残胰重建方式为简易胰肠套入捆绑式吻合方式手术者32例（简易组）,胰空肠端端常规套入吻合手术者24例（常规组）;比较两组的胰肠吻合手术时间、术中出血量、术后住院时间等情况;并根据Clavien术后并发症诊断和分级标准分析此两种吻合方式与术后并发症发生率及其严重程度的关系.结果 简易吻合组的术中出血量与常规吻合组比较差异无统计学意义（P＞0.05）,而两组胰肠吻合时间、术后住院时间相比较有统计学意义（P＜0.05）;在术后并发症的严重程度分级中简易吻合组的Ⅱ级和Ⅴ级并发症发生率分别为9.36％ （3/32）和3.13％ （1/32）,显著低于常规吻合组的25.00％ （6/24）和12.5％ （3/24）,两组比较,差异有统计学意义（P＜0.05）.结论 在行胰十二指肠切除术中使用简易胰肠套入捆绑式吻合方式明显降低术后并发症的发生率,缩短胰肠吻合手术时间及术后住院时间,可能更有利于患者术后的恢复,此吻合方式值得在临床工作中推广运用.

A simple Pancreaticojejunostomy bundled set into the clinical application of anastomosis observation

Objective To explore the simple of pancreaticoduodenal resection of pancreatic intestinal into the clinical value of bundled anastomosis.Methods Retrospectively analyzed in May 2003 to May 2003 in our hospital clinical data of 56 patients of pan-creaticoduodenal resection,reconstruction of residual pancreatic simple distal intestinal surgery into a bundled anastomosis ways 32 cases （simple）,distal jejunum routine set of end to end into the anastomosis surgery （normal group） 24 cases; Comparison of two groups of pancreatic anastomosis operation time,intraoperative blood loss,postoperative hospital stay,and so on and so forth; Diagnosis and classification standard and according to the Clavien postoperative complications analysis this two types of anastomosis and the postoperative complications incidence and severity of the relationship.Results Simple anastomosis of intraoperative blood loss,there was no statistically significant difference compared with conventional anastomosis group （P ＞ 0.05）,and two groups of pancreatic anastomosis time,postoperative hospital stay compared with statistical significance （P ＜ 0.05） ; In the postoperative complications of severity classification of simple anastomosis of Ⅱ level and grade Ⅴ complication rates were 9.36％ （3/32） and 3.13％ （1/32）,significantly lower than normal anastomosis of 25.00％ （6/24） and 12.5 ％ （3/24）,two groups of comparison,the difference was statistically significant （P ＜0.05）.Conclusion In line of pancreaticoduodenal resection using simple pancreatic intestinal into bundled anastomosis way to significantly reduce the incidence of postoperative complications,shorten the pancreatic anastomosis operation time and postoperative hospital stay,may be more beneficial to patients with postoperative recovery,the match way is worth popularization in clinical work.