大网膜包裹胰肠吻合口预防术后胰瘘的临床疗效

发布时间：2018-04-17 17:40

本文选题：胰十二指肠切除术 + 胰肠吻合　；参考：《遵义医学院》2017年硕士论文

【摘要】：目的:探讨利用大网膜包裹胰肠吻合口对胰十二指肠切除术后胰瘘发生及恢复情况的影响,评价该技术的实际临床运用效果。方法:回顾性分析四川省人民医院肝胆胰脾外科细胞移植中心同一治疗组2011年1月至2016年12月行胰十二指肠切除术(Pancreaticoduodenectomy,PD)77例病人的临床资料。根据胰肠吻合口处理方式分为大网膜包裹组(31例)和非大网膜包裹组(46例)。其中大网膜包裹组男性18例,女性13例;年龄区间为31-76岁,平均年龄为62.58±10.39岁。非大网膜包裹组男性25例,女性21例;年龄区间为21-78岁,平均年龄为59.20±12.78岁。统计分析两组病人术前一般资料(年龄、性别、体重指数、总胆红素、白蛋白、腹部手术史、术前合并症),术中一般资料(手术时间、出血量、输血例数、胰腺质地、胰管直径等)及术后病理资料,术后并发症资料(围手术期死亡、胰瘘、出血、胆漏、腹腔积液、腹腔感染、肠梗阻、肺部感染、切口感染、多器官功能障碍),术后一般资料(ICU住院时间、胃管留置时间、引流管留置时间、术后住院时间、再次手术率等),观察大网膜包裹胰肠吻合口预防胰十二指肠切除术后胰瘘发生及术后恢复情况,探讨该技术的实际临床效果。结果:1.大网膜包裹组与非包裹组术前一般资料(性别、年龄、体重指数、白蛋白、总胆红素、腹部手术史、术前穿刺减黄例数及术前合并症)比较差异无统计学意义(P0.05)。2.大网膜包裹组与非包裹组术中一般资料(手术时间、出血量、输血例数、胰液引流方式、胰腺质地、胰管直径)及术后病理资料比较差异无统计学意义(P0.05)。3.大网膜包裹组术后并发症8例(25.81%),非包裹组19例(41.30%);术后死亡5例(6.49%),其中大网膜包裹组1例(3.23%),非大网膜包裹组4例(8.70%)。大网膜包裹组与非包裹组在术后总并发症率和死亡率比较差异无统计学意义(P0.05)。4.大网膜包裹组术后发生生化漏2例(6.46%),非包裹组11例(23.91%),两组比较差异有统计学意义(P0.05)。5.大网膜包裹组术后出现B级胰瘘1例(3.23%),C级胰瘘1例(3.23%);非包裹组术后B级胰瘘2例(4.35%),C级胰瘘2例(4.35%)。大网膜包裹组与非包裹组术后胰瘘发生率(B+C级)比较差异无统计学意义(P0.05)。6.大网膜包裹组与非包裹组在术后出血(0.00%vs6.52%)、胃排空障碍(0.00%vs4.35%)、腹腔积液(6.45%vs19.57%)、腹腔感染(6.45%vs15.22%)、肠梗阻(0.00%vs2.17%)、多器官功能障碍(0.00%vs4.35%)等并发症发生率比较差异无统计学意义(P0.05)。7.大网膜包裹组与非包裹组术后一般资料(ICU住院时间、术后输血例数、胃管留置时间、引流管留置时间、术后住院时间、再次手术率)比较差异无统计学意义(P0.05)。结论:1.大网膜包裹胰肠吻合口不能降低PD术后胰瘘(B、C级)的发生率。2.大网膜包裹胰肠吻合口能降低术后生化漏的发生率,但对PD术后并发症发生率及术后恢复无明显影响。
[Abstract]:Objective: to investigate the effect of greater omentum encapsulated pancreaticojejunostomy on the occurrence and recovery of pancreatic fistula after pancreatoduodenectomy, and to evaluate the clinical effect of this technique.Methods: the clinical data of 77 cases of Pancreatic duodenectomy with Pancreatic duodenectomy were retrospectively analyzed in the same treatment group in the center of liver, bile, pancreas, pancreas and spleen surgery of Sichuan Provincial people's Hospital from January 2011 to December 2016.According to the management of pancreaticojejunostomy, there were 31 cases in omentum group and 46 cases in non-omentum group.There were 18 males and 13 females in the omentum group with an age range of 31-76 years (mean 62.58 卤10.39 years).There were 25 males and 21 females in non-omentum group, the age range was 21-78 years, the average age was 59.20 卤12.78 years.The preoperative general data (age, sex, body mass index, total bilirubin, albumin, history of abdominal surgery, preoperative complications, intraoperative data (time of operation, amount of blood loss, number of cases of blood transfusion, pancreatic texture) were analyzed statistically.Pancreatic duct diameter, postoperative pathological data, postoperative complications (perioperative death, pancreatic fistula, bleeding, bile leakage, peritoneal effusion, abdominal infection, intestinal obstruction, lung infection, incisional infection), postoperative complications (perioperative death, pancreatic fistula, bleeding, bile leakage, peritoneal effusion, abdominal infection, intestinal obstruction, lung infection, incisional infection),Multiple organ dysfunction, postoperative general data, ICU stay time, gastric tube retention time, drainage tube retention time, postoperative hospitalization time,To observe the prevention of pancreatic fistula and recovery after pancreatoduodenectomy with greater omentum wrapped pancreaticojejunostomy, and to explore the practical clinical effect of this technique.The result is 1: 1.There was no significant difference in preoperative data (sex, age, body mass index, albumin, total bilirubin, history of abdominal surgery, number of cases of preoperative yellow reduction and preoperative complications) between omentum group and unwrapped group (P 0.05. 2).There was no significant difference in general data (operation time, blood loss, blood transfusion, pancreatic fluid drainage, pancreatic texture, pancreatic duct diameter) and postoperative pathological data between the omentum encapsulation group and the unencapsulated group (P 0.05. 3).The postoperative complications were 25.81 in the omentum group and 41.30 in the unwrapped group, and the postoperative death was 6.49 in 5 cases, including 3.23 in the greater omentum group and 8.70 in the non-omentum wrapping group.There was no significant difference in the rate of postoperative complications and mortality between the omentum encapsulation group and the unencapsulated group (P 0.05. 4).Biochemical leakage occurred in 2 cases in the greater omentum group and in 11 cases in the unwrapped group. The difference between the two groups was statistically significant (P 0.05).In the group of greater omentum encapsulation, there were 1 case of grade B pancreatic fistula, 1 case of grade C fistula and 2 cases of grade B fistula, 2 cases of grade C fistula, and 2 cases of grade C fistula.There was no significant difference in the incidence of pancreatic fistula between the greater omentum encapsulation group and the unencapsulated group (P 0.05. 6).There was no significant difference in the incidence of complications between the greater omentum group and the unencapsulated group in postoperative hemorrhage (0.00vs6.52), gastric emptying disorder (0.00vs4.35m), peritoneal effusion (6.45vs19.57m), abdominal infection (6.45vs15.22g), intestinal obstruction (0.00vs2.17d), and multiple organ dysfunction (0.00vs4.35B).There was no significant difference in postoperative hospitalization time, blood transfusion cases, gastric tube indwelling time, drainage tube indwelling time, postoperative hospitalization time and reoperation rate between omentum encapsulation group and unwrapped group (P 0.05).Conclusion 1.Greater omentum encapsulation of pancreaticojejunostomy did not decrease the incidence of pancreatic fistula (grade C) after PD.Greater omentum encapsulation of pancreaticojejunostomy can reduce the incidence of postoperative biochemical leakage, but has no significant effect on the incidence of postoperative complications and postoperative recovery of PD.
【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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