胰腺空肠端端套入式间断U型缝合法在胰十二指肠切除术中的应用

发布时间：2018-06-08 00:01

本文选题：胰十二指肠切除术 + 胰肠吻合　；参考：《吉林大学》2017年硕士论文

【摘要】：目的探讨胰腺空肠端端套入式间断U型缝合法在胰十二指肠切除术中的应用价值。方法回顾性分析2006年8月至2016年6月我科收治的263例行胰十二指肠切除术患者的临床资料,根据吻合方式分为胰腺空肠端端套入式间断U型缝合组和胰管-空肠粘膜端侧胰肠吻合组。U型吻合组患者176例,胰管-空肠粘膜吻合组患者87例,两组患者的一般资料相比,差异无统计学意义(P0.05),具有可比性。观察两组患者手术时间、术中出血量和输血量、术后引流管拔除时间、术后住院时间以及胰瘘、腹腔内感染、腹腔出血、胆瘘、胃排空延迟和死亡等指标发生率的差异。服从正态分布的计量资料以均数±标准差即((?)±s)形式表示,并采用t检验。不服从正态分布的计量资料以中位数(四分位间距)即M(Q)形式表示,并采用秩和检验。计数资料采用c2检验,对部分结果应用Fisher精确概率法检验。P0.05为差异有统计学意义。结果U型吻合组患者手术时间5.50(1.00)h明显低于胰管-空肠粘膜吻合组患者7.00(2.75)h(P0.05)。U型吻合组患者术中出血量300.00(400.00)ml明显低于胰管-空肠粘膜吻合组患者400.00(500.00)ml(P0.05)。263例患者术后总体胰瘘发生率7.6%,其中U型吻合组患者胰瘘发生率5.1%。胰管-空肠粘膜吻合组患者胰瘘发生率12.6%。U型吻合组患者术后胰瘘发生率和B级胰瘘发生率明显低于胰管-空肠粘膜吻合组患者(P0.05),两组患者A级和C级胰瘘发生率差异无统计学意义(P0.05)。两组患者术中输血量、术后引流管拔除时间、术后住院时间以及其他主要术后并发症发生率差异无统计学意义(P0.05)。结论胰腺空肠端端套入式间断U型缝合法操作简单,吻合安全,可以有效降低PD术后胰瘘特别是较严重胰瘘的发生率,同时不会增加患者术后的身体和经济负担,具有较大的临床应用价值。
[Abstract]:Objective to evaluate the value of discontinuous U-suture at the end-to-end of pancreas jejunum in pancreaticoduodenectomy. Methods the clinical data of 263 cases of pancreaticoduodenectomy treated in our department from August 2006 to June 2016 were analyzed retrospectively. According to the anastomosis mode, 176 cases were divided into two groups: pancreatic jejunal end to end insertion discontinuous U suture group, pancreatic duct jejunum mucosal end to side pancreaticojejunostomy group, and pancreatic duct jejunum mucosal anastomosis group, 87 cases. The general data of the two groups were compared. The difference was not statistically significant (P 0.05) and was comparable. The time of operation, the amount of blood loss and blood transfusion, the time of extubation of drainage tube, the time of hospitalization, the incidence of pancreatic fistula, intraperitoneal infection, intraperitoneal hemorrhage, biliary fistula, gastric emptying delay and death were observed between the two groups. The measurement data of normal distribution were expressed in the form of mean 卤standard deviation (卤s), and t test was used. The measurement data from normal distribution are expressed in the form of median (quartile spacing) or MQs, and rank sum test is used. The counting data were measured by c2 test, and Fisher exact probability test was used to test some results. The difference was statistically significant. Results the operative time of patients with U-type anastomosis was significantly lower than that of patients with pancreaticojejunostomy (5.50 ~ 1.00 h) compared with that of patients with pancreatic duct and jejunal mucosal anastomosis (7.00 ~ 2.75) (P 0.05) .U type anastomosis group was significantly lower than that of pancreatic duct and jejunal mucosal anastomosis group (400.0050). The incidence of pancreatic fistula was 5.1 in U type anastomosis group. The incidence of pancreatic fistula in the pancreatic duct jejunum anastomosis group was significantly lower than that in the pancreatic duct jejunum mucosal anastomosis group (P 0.05). The incidence of pancreatic fistula in the U type anastomosis group was significantly lower than that in the pancreatic duct jejunal mucosal anastomosis group (P 0.05). The difference was not statistically significant (P 0.05). There was no significant difference in the amount of blood transfusion, the time of extubation, the time of hospitalization and the incidence of other major postoperative complications between the two groups (P 0.05). Conclusion the operation of discontinuous U-type suture at the end of jejunum of pancreas is simple and safe, which can effectively reduce the incidence of pancreatic fistula, especially severe pancreatic fistula, without increasing the body and economic burden of the patients after PD. It has great clinical application value.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.5

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