大网膜包裹胰肠吻合口在胰十二指肠切除术中的应用体会

目的 探讨采用大网膜包裹胰肠吻合口方法预防胰十二指肠切除术后胰瘘的效果。方法 回顾性分析江门市中心医院肝胆胰脾外科自2018年1月至2020年12月78例行胰十二指肠切除术患者的临床资料,其中38例胰十二指肠切除联合大网膜包绕胰肠吻合口（包绕组）,40例仅行胰十二指肠切除术（未包绕组）,比较两组术前、术中、术后相关临床指标。结果 两组患者年龄、性别、术前白蛋白、术前总胆红素、胰腺质地、胰管直径和手术时间差异均无统计学意义（均P>0.05）。虽然术后两组的胰漏发生率差异无统计学意义,但包绕组术后胰漏分级均为A级胰漏,未见B、C级胰漏,而未包绕组A级胰漏2例,B级胰漏5例,C级胰漏1例,差异具有统计学意义（P=0.003）;术后包绕组出现2例胃排空延迟,而未包绕组出现1例胆漏,5例术后出血,3例胃排空延迟,除了1例术后腹腔出血需行介入治疗外,其余患者均予以保守治疗而治愈,两组差异无统计学意义（P=0.231）;术后住院时间（1.5±3.0天 vs. 17.4±6.8天,P<0.001）及住院费用（106442±16230 vs. 129831±35875元,P<0.001）包绕组较为包绕组明显减少（P<0.05）。结论 采用大网膜包绕胰肠吻合口方法可以减轻胰十二指肠切除术后胰瘘程度,促进术后胰漏愈合,未增加腹腔感染、腹腔脓肿、胃排空延迟等严重并发症发生,且可减少住院时间及住院费用,且方法简单、易操作。

Experience in the application of greater omentum wrapping pancreaticoenteric anastomotic stoma in preventing pancreatic leakage in pancreaticoduodenectomy

Objective The aim of this study was to explore the effect of by using greater omentum to wrap the pancreaticoenteric anastomotic stoma in preventing pancreatic leakage after pancreaticoduodenectomy （PD）. Methods From January 2018 to December 2020 in Jiangmen Central Hospital, a total of 78 paitients undergoing PD were enrolled in the retrospective study, including 38 patients using the greater omentum to wrap the pancreaticoenteric anastomotic stoma after PD （experimental group） and 40 patients underwent PD only （control group）. Preoperative, intraoperative and postoperative clinical factors were compared between two groups. Results No significant differences in age, gender, preoperative albumin, preoperative total bilirubin, pancreatic texture, pancreatic duct diameter and operative time between two groups were observed （P>0.05）. Even though the pancreatic fistula rate of the experimental group was not differ significantly from the control group, only grade A pancreatic fistula were observed in the experimental group without grade B or C, while there were 2 cases of grade A pancreatic fistula, 5 cases of grade B pancreatic fistula and 1 case of grade C pancreatic fistula in the control group. And this difference between the two group was significant （P=0.003）. Delayed gastric emptying occurred in 2 patients in the experimental group after PD, while 3 cases of delayed gastric emptying, 1 case of biliary leakage and 5 cases of postoperative bleeding were observed in the control group after PD. And one of postoperative bleeding was cured by interventional therapy. The total complication rates between two groups were not significant different（P=0.231）. Postoperative hospitalization time （11.5±3.0 days vs. 17.4±6.8 days, P<0.001） and hospitalization cost （106442±16230 vs. 129831±35875 yuan, P<0.001） were significantly reduced in the experimental group compared with the control group （P<0.05）. Conclusion Using greater omentum to wrap the pancreaticoenteric anastomotic stoma could reduce the degree of pancreatic fistula after PD, promote the healing of postoperative pancreatic fistula, reduce length of stay and hospitalization costs, without increase of abdominal infection, abdominal abscess, delayed gastric emptying and other serious complications. And also this is a simple, convenient procedure.