袖套式prolene线单层连续缝合在胰肠吻合中的应用

目的:探讨袖套式prolene线单层连续缝合在胰肠吻合中的应用价值。方法:采用前瞻、随机对照设计,将2009年8月—2014年3月124例行胰十二指肠切除术(PD)患者根据不同胰肠吻合方式分为3组,分别采用传统端端或端侧套入式吻合(套入式吻合组),胰管空肠黏膜端侧吻合(黏膜端侧吻合组),袖套式prolene线单层连续缝合(袖套式缝合组),比较各组胰瘘发生率及其他手术相关指标。结果:袖套式缝合组的胰肠吻合时间明显短于另两组(均P<0.05);全组总胰瘘发生率18.5%(23/124),袖套式缝合组胰瘘发生率(4.8%)明显低于套入式吻合组(29.3%)与黏膜端侧吻合组(22.0%)(均P<0.05);3组间其他并发症差异均无统计学意义(均P>0.05)。按胰管直径与胰腺质地分层后的组间比较显示,胰管直径<3 mm时,袖套式缝合组胰瘘发生率(7.1%)明显低于黏膜端侧吻合组(50.0%)(P<0.05);软质地胰腺时,袖套式缝合组胰瘘发生率(11.8%)明显低于套入式吻合组(53.3%)与黏膜端侧吻合组(53.8%)(均P<0.05)。按胰管直径与胰腺质地分层后的组内比较显示,套入式吻合组中,硬质地胰腺亚组胰瘘发生率(15.4%)明显低于软质地亚组(53.3%)(P<0.05);黏膜端侧吻合组中,大直径胰腺亚组(7.4%)胰瘘发生率明显低于小直径胰管亚组(50.0%),硬质地亚组胰瘘发生率(7.1%)明显低于软质地亚组(53.8%)(均P<0.05);袖套式缝合组中,各亚组间差异无统计学意义(均P>0.05)。结论:袖套式prolene线单层连续缝合方法安全简便,能降低PD术后的胰瘘发生率,尤其在胰管直径<3 mm或软胰腺质地时采用此法优势明显。

Sleeve anastomosis with single layer continuous prolene suture in pancreaticojejunostomy

Objective: To investigate the value of application of sleeve anastomosis with single-layer continuous prolene suture in pancreaticojejunostomy. Methods: Using a prospective randomized design, 124 patients scheduled to undergo pancreaticoduodenectomy (PD) from August 2009 to March 2014 were divided into three groups, according to different pancreaticojejunostomy methods that included the conventional end-to-end or end-to-side invagination anastomosis (invagination anastomosis group), mucosa-to-mucosa anastomosis of the pancreatic duct to the jejunum (mucosa-to-mucosa anastomosis group) and sleeve anastomosis with single-layer continuous prolene suture (sleeve anastomosis group). The incidence of pancreatic fistula and other surgical variables among the three groups were compared. Results: The operative time for pancreaticojejunostomy in sleeve anastomosis group was significantly shortened compared with invagination anastomosis group or mucosa-to-mucosa anastomosis group (both P<0.05); the incidence of pancreatic fistula in the entire group was 18.5% (23/124), which in sleeve anastomosis group (4.8%) was significantly lower than that in invagination anastomosis group (29.3%) or mucosa-to-mucosa anastomosis group (22.0%) (both P<0.05); There was no significant difference in incidences of other complications (all P>0.05). Intergroup comparison after stratification by pancreatic duct size and pancreatic texture showed that the incidence of pancreatic fistula in those with pancreatic duct diameter less than 3 mm in sleeve anastomosis group (7.1%) was significantly lower than that in mucosa-to-mucosa anastomosis group (50.0%); the incidence of pancreatic fistula in those with soft pancreatic texture in sleeve anastomosis group (11.8%) was significantly lower than that in either invagination anastomosis group (53.3%) or mucosa-to-mucosa anastomosis group (53.8%) (both P<0.05). Intragroup comparison after stratification by pancreatic duct size and pancreatic texture showed that the incidence of pancreatic fistula in firm pancreatic texture subgroup (15.4%) was significantly lower than that in soft pancreatic texture subgroup (53.3%) in invagination anastomosis group (P<0.05); incidence of pancreatic fistula in large pancreatic duct subgroup (7.4%) was significantly lower than that in small pancreatic duct subgroup (50.0%), and in firm pancreatic texture subgroup (7.1%) was significantly lower than that in soft pancreatic texture subgroup (53.8%) in mucosa-to-mucosa anastomosis group (both P<0.05); there was no significant difference between either subgroups of sleeve anastomosis group (both P>0.05). Conclusion: Sleeve anastomosis with single-layer continuous prolene suture is a safe and convenient procedure, and can reduce the incidence of post-PD pancreatic fistula, especially for those with pancreatic duct diameter less than 3 mm, or soft pancreatic texture.