胰腺残端捆绑式结扎在胰腺远端切除术中的应用

发布时间：2018-05-12 08:06

本文选题：胰腺远端切除术 + 胰腺残端　；参考：《遵义医学院》2017年硕士论文

【摘要】：目的:探讨胰腺残端捆绑式结扎对胰腺远端切除术(Distal Pancreatectomy,DP)术后胰瘘(Postoperative Pancreatic Fistula,POPF)发生的影响,评价其安全性、有效性。方法:回顾性分析四川省人民医院肝胆胰中心于2012年1月~2017年1月因胰腺体尾部疾病择期开腹行胰腺远端切除术患者的临床资料112例。根据胰腺远端切除术中胰腺残端是否捆绑,分为胰腺残端捆绑式结扎组(捆绑组)53例和胰腺残端非捆绑式结扎组(非捆绑组)59例。以上两组分别又根据胰腺残端闭合方式不同分为手工缝合和闭合器两亚组;其中在捆绑组亚组中手工缝合39例、闭合器14例,而在非捆绑组亚组中则分别为40例、19例。对以上患者术前一般资料(性别、年龄、体重指数、血红蛋白、白蛋白、总胆红素、合并疾病、腹部手术史),术中一般资料(胰腺残端闭合方式、手术时间、术中出血量、术中输血例数、脾切除例数、联合血管切除例数、联合其他脏器切除例数、胰腺质地)及术后病理资料,术后恢复、随访资料(腹腔引流管引流量、术后输血例数、引流管留置时间、术后住院时间、住院费用、再次手术例数、出院一月内再次入院例数等资料)进行对比分析;并就患者术后并发症的发生率,尤其是对术后胰瘘等并发症的发生率进行统计分析。结果:1.捆绑组和非捆绑组患者术前一般资料(性别、年龄、体重指数、血红蛋白、白蛋白、总胆红素、腹部手术史、术前合并症)比较无统计学差异(P0.05)。2.在捆绑组亚组和非捆绑组亚组中,手工缝合和闭合器患者术前一般资料(性别、年龄、体重指数、血红蛋白、白蛋白、总胆红素、腹部手术史、术前合并症)比较亦均无统计学差异(P0.05)。3.捆绑组和非捆绑组患者术中一般资料及术后病理资料(胰腺残端闭合方式、手术时间、术中出血量、术中输血例数、脾切除例数、联合血管切除例数、联合其他脏器切除例数、胰腺质地、病理诊断)比较无统计学差异(P0.05)。4.所有患者均无围手术期死亡,术后发生并发症总计35例,发生率为31.3%(35/112)。其中,捆绑组发生并发症12例,发生率为22.6%(12/53);非捆绑组发生并发症23例,发生率为39.0%(23/59)。捆绑组术后并发症发生率明显低于非捆绑组,但两组间差异无统计学意义(P0.05)。(1)捆绑组和非捆绑组患者在术后胰瘘(B级+C级)发生方面,捆绑组发生术后胰瘘2例,非捆绑组发生术后胰瘘10例,发生率分别为3.8%(2/53)、17.0%(10/59),两组间比较存在统计学差异(P0.05)。(2)在胰瘘分级方面,捆绑组发生B级胰瘘2例,非捆绑组发生B级胰瘘9例,发生率分别为3.8%(2/53)、15.3%(9/59),两组间比较亦存在统计学差异(P0.05);而在生化漏(A级)及C级胰瘘发生率方面,两组间比较无统计学意义(P0.05)。(3)在捆绑组亚组和非捆绑组亚组中,手工缝合组的术后胰瘘发生率分别为2.6%(1/39)、15.0%(6/40);闭合器组的术后胰瘘发生率分别为7.1%(1/14)、21.1%(4/19)。经比较,闭合器组的术后胰瘘发生率均明显高于手工缝合组(7.1%VS 2.6%,21.1%VS15.0%),但差异无统计学意义(P0.05);在胰瘘分级方面,手工缝合组与闭合器组比较亦均无统计学意义(P0.05)。(4)捆绑组和非捆绑组患者在术后出血(1.9%VS 0%)、胃排空障碍(1.9%VS 0%)、腹腔积液(13.2%VS 20.3%)、腹腔感染(1.9%VS 8.5%)、肠梗阻(5.7%VS 1.7%)、切口感染(3.8%VS 6.8%)等并发症发生率上无统计学差异(P0.05)。5.在术后恢复及随访资料方面,捆绑组腹腔引流管的引流量与非捆绑组在术后前3天比较无明显统计学差异(P0.05),而在第4天、第5天捆绑组的引流量明显少于非捆绑组,差异有统计学意义(P0.05)。此外,捆绑组在引流管留置时间(8d VS 12d)、术后住院时间(9d VS 13d)、住院费用(46165.85±11120.29元VS 51751.14±15675.09元)方面优于非捆绑组且有统计学差异(P0.05)。而在术后输血例数、再次手术例数以及出院一月内再次入院例数等方面,两组间比较无统计学意义(P0.05)。结论:1、胰腺残端捆绑式结扎可有效降低胰腺远端切除术术后胰瘘的发生率,尤其对B级胰漏的预防效果较为显著。2、胰腺残端捆绑式结扎能够有效加强残端封闭效果,在降低术后胰瘘发生率的同时,亦可减少术后腹腔引流管的引流量,缩短引流管留置时间,减少住院天数,促进患者恢复并降低住院费用,减轻经济负担。3、捆绑式结扎可能通过有效降低胰腺残端手工缝合的密度和闭合器封闭的不确定性因素,进而减少手术操作对胰腺组织的损伤,是一种简单、安全、有效的方法。
[Abstract]:Objective: To investigate the effects of binding pancreatic ligature on the occurrence of pancreatic fistula (Postoperative Pancreatic Fistula, POPF) after Distal Pancreatectomy (DP) and evaluate its safety and effectiveness. Methods: a retrospective analysis of the liver and gallbladder center of the Sichuan Provincial People's Hospital in January January 2012 for the disease of the body and tail of the pancreas in January ~2017. The clinical data of 112 patients with distal pancreatic resection were performed. According to the binding of the pancreatic residues in the distal pancreas resection, 53 cases were divided into the bundle ligature group (bundle group) and the non binding group (non binding group) of the pancreatic residue 59 cases. The above two groups were divided into manual suture according to the difference of the pancreatic stump closure. In the subgroup two, 39 were hand sutured in the bundling group, 14 were closed in the closed group, and 40 in the non binding group, and 19 in the non binding group. The general data (sex, age, body mass index, hemoglobin, albumin, total bilirubin, hemoglobin, total bilirubin, the history of abdominal surgery), and the general data of the operation (closure of the pancreatic stump closure) in the subgroup of the non binding group. Methods, operation time, intraoperative bleeding, intraoperative blood transfusion, number of splenectomy cases, number of combined splenectomy cases, number of combined resection of other organs, pancreas texture and postoperative pathological data, postoperative recovery, follow-up data (abdominal drainage tube flow, number of postoperative blood transfusion, drainage tube indwelling time, postoperative hospital stay, hospitalization expenses, reoperation) The incidence of postoperative complications, especially the incidence of postoperative complications such as pancreatic fistula, was statistically analyzed. Results: the general data (sex, age, body mass index, hemoglobin, albumin, total bilirubin, total bilirubin) in 1. bundles and unbundled groups were analyzed. The history of abdominal surgery, preoperative complication) had no statistical difference (P0.05).2. in the bundling group subgroup and the non bundle group, the general data (sex, age, body mass index, hemoglobin, albumin, total bilirubin, abdominal hand history, preoperative amalgamation) were also not statistically different (P0.05).3. bundling. The general data and postoperative pathological data in group and non binding group (pancreatic stump closure, operation time, intraoperative bleeding, number of intraoperative blood transfusions, number of splenectomy cases, combined number of excision cases, combined with other organ resection cases, pancreas texture and pathological diagnosis) had no statistical difference (P0.05) all patients of.4. had no perioperative period. The incidence of postoperative complications occurred in 35 cases, with a total incidence of 31.3% (35/112). Among them, there were 12 cases of complications in the bundling group, 22.6% (12/53), 23 cases in the non binding group and 39% (23/59). The incidence of complications in the bundle group was significantly lower than that in the non binding group, but there was no significant difference between the two groups (P0.05). (1) bundling (1) bundling. There were 2 cases of pancreatic fistula (grade B +C) in group and non bundle group, 2 cases of pancreatic fistula in binding group and 10 cases of pancreatic fistula in non binding group, 3.8% (2/53) and 17% (10/59), respectively (P0.05). (2) there were 2 cases of B grade pancreatic fistula in the bundle group and B grade pancreas in the non binding group. The incidence of fistula in 9 cases was 3.8% (2/53), 15.3% (9/59), and there was a statistical difference between the two groups (P0.05), but there was no significant difference between the two groups (3) in the biochemical leakage (a grade) and the C grade pancreatic fistula (3) the incidence of pancreatic fistula after the manual suture group was 2.6% (1/39), 15% (6) in the bundle subgroup and the non bundle group. /40): the incidence of pancreatic fistula in the closed group was 7.1% (1/14) and 21.1% (4/19). After comparison, the incidence of pancreatic fistula in the closure group was significantly higher than that in the manual suture group (7.1%VS 2.6%, 21.1%VS15.0%), but the difference was not statistically significant (P0.05), and there was no significant difference between the manual suture group and the closure group in the classification of the pancreatic fistula (P0.05 (4) the incidence of postoperative bleeding (1.9%VS 0%), gastric emptying disorder (1.9%VS 0%), peritoneal effusion (13.2%VS 20.3%), abdominal infection (1.9%VS 8.5%), intestinal obstruction (5.7%VS 1.7%), incision infection (3.8%VS 6.8%) and other complications in binding group and non bundle group (P0.05).5. in postoperative recovery and follow-up data, binding group intraperitoneal There was no significant difference between the drainage volume of the flow tube and the non binding group in the first 3 days after the operation (P0.05), but on the fourth day, the drainage volume in the fifth day bundle group was significantly less than that in the non binding group (P0.05). In addition, the binding group was in the drainage tube retention time (8D VS 12D), the postoperative hospital stay (9D VS 13D), and the hospitalization expenses (46165.85 + 11120.29). VS 51751.14 + 15675.09 yuan) was superior to that of non binding group and had statistical difference (P0.05), but there was no significant difference between the two groups in the number of blood transfusion, the number of reoperation cases and the number of hospitalized cases again within one month (P0.05). Conclusion: 1, the bundle ligature of the pancreatic stump can effectively reduce the pancreatic fistula after the distal excision of the pancreas. The incidence of the pancreatic leakage, especially for the B leaks, is.2. The binding of the pancreatic stump can effectively strengthen the effect of the residual end closure. It can reduce the incidence of postoperative pancreatic fistula, reduce the drainage volume of the postoperative abdominal drainage tube, shorten the retention time of the drainage tube, reduce the number of days of hospitalization, promote the recovery of the patients and reduce the cost of hospitalization. To reduce the economic burden of.3, binding type ligation may be a simple, safe and effective way to reduce the surgical operation on pancreatic tissue damage by effectively reducing the density of the manual suture of the pancreatic stump and the uncertainty of closure of the closure of the closet.

【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.5

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