两种减压管放置方法对胰十二指肠切除术后胰瘘的影响分析

目的:探讨胰十二指肠切除术(PD)后减压管的两种放置方法对术后胰瘘发生的影响。方法:回顾性分析2012年1月—2014年10月期间收治的125例行胰十二指肠切除术患者的临床资料。其中68例于主胰管放置引流管减压(胰管组),57例于胰肠吻合口盲端远端置引流管减压(盲襻组),比较两组术后胰瘘发生率及其他临床指标。结果:全组共发生胰瘘9例(7.2%),其中盲襻组1例(1.8%),胰管组8例(11.8%),所有患者均经过保守治疗治愈出院,盲襻组胰瘘发生率明显低于胰管组(P0.05),其他并发症发生率两组间差异均无统计学意义(均P0.05);盲襻组住院时间(20.38dvs.27.46d)及住院费用(5.642万元vs.6.602万元)均少于胰管组(均P0.05);两组患者术后1年肿瘤复发率、生存率差异无统计学意义(均P0.05)。结论:PD术中盲攀减压管的放置能有效降低术后胰瘘的发生。

Effects of two different decompression tube placement methods on pancreatic fistula after pancreaticoduodenectomy

Objective: To investigate the effects of two different decompression tube placement methods on pancreatic fistula after pancreaticoduodenectomy (PD). Methods: The clinical data of 125 patients undergoing PD from January 2012 to October 2014 were retrospectively analyzed. Of the patients, 68 cases underwent decompression by insertion of a drainage tube into the main pancreatic duct (pancreatic duct group), and 57 cases underwent decompression by insertion of a drainage tube into the distal part of the blind end of the pancreatic jejunal anastomosis (blind loop group). The incidence of postoperative pancreatic fistula and other clinical variables between the two groups were compared. Results: Pancreatic fistula occurred in 9 cases (7.2%) in the entire group, with one case (1.8%) in blind loop group and 8 cases (11.8%) in pancreatic group, and all cases were cured by conservative treatment and discharged from hospital. The incidence of pancreatic fistula in blind loop group was significantly lower than that in pancreatic duct group (P<0.05), but there was no statistical difference in incidence of other complications between the two groups (all P>0.05). In blind loop group compared with pancreatic duct group, the length of hospital stay (20.38 d vs. 27.46 d) and hospitalization cost (56 420 yuan vs. 66 020 yuan) were significantly reduced (both P<0.05). No statistical difference was noted in postoperative 1-year tumor recurrence and survival rate between the two groups (both P>0.05). Conclusion: The decompression tube placement via blind loop can effectively reduce the incidence of postoperative fistula after PD.