胰管空肠黏膜连续吻合技术在胰腺空肠吻合中的应用研究

发布时间：2018-05-22 11:20

本文选题：胰头十二指肠切除术 + 胰管空肠黏膜吻合术　；参考：《河北医科大学》2015年硕士论文

【摘要】：目的:胰头十二指肠切除术(pancreatoduodenetomy,PD)是主要用于治疗胰头部、胆总管末端及十二指肠乳头、壶腹部等良恶性疾病的经典术式,PD涉及脏器多,操作时间长,术中出血多,技术难度大,是腹部外科挑战性最大的手术之一。尽管近年胰腺外科领域取得了很大的进步,手术技术不断改进,护理水平不断提高,该术式的死亡率目前已降至5%左右,然而,其术后并发症的发生率仍然高达30%~60%。其中胰瘘(pancreatic fistula,PF)是最常见、最危险的并发症之一,其发生率在2%~20%。本研究旨在探讨胰管空肠黏膜Prolene线连续吻合技术在胰肠吻合中的应用价值。方法:回顾性分析2013年6月至2015年6月在河北医科大学第四医院肝胆外科行胰头十二指肠切除术的165例病人的临床资料,其中行胰管空肠黏膜Prolene线连续吻合术的病人53例,采用普通嵌套式胰肠吻合的病人112例。比较两组间胰瘘的发生率有无显著性差异。统计学分析应用SPSS 21.0统计软件包进行,统计分析采用χ2检验,以P0.05为差异有显著性。结果:施行胰头十二指肠切除术的全部165例病历资料中,有69例发生术后并发症(发生率41.8%),其中主要并发症为腹腔感染(36例,发生率21.8%),胰瘘(19例,发生率11.5%),消化道出血(17例,发生率10.3%);手术期死亡2例(死亡率1.2%)。行胰管空肠黏膜Prolene线连续吻合术的53例病人,术后仅2例发生胰瘘,且均为A级,经抑酶等对症治疗后,胰瘘均消失,胰瘘发生率为3.8%(2/53);而采用普通嵌套式胰肠吻合的112例病人,术后有17例发生胰瘘,胰瘘发生率为15.2%(17/112),两组间差异具有显著性(χ2=4.493,P=0.037)。结论:胰管空肠黏膜Prolene线连续吻合技术是采取连续吻合主胰管及空肠全层,吻合确切,不易发生胰瘘,受胰腺质地影响较小,且Prolene线针线一体,线体光滑,摩擦力较小,适于连续吻合。此吻合方式便捷可行,能明显降低胰瘘的发生率,是一种安全可行的吻合方式。
[Abstract]:Objective: Pancreatoduodenetomyus (PDD) is a classic procedure for the treatment of benign and malignant diseases such as the head of pancreas, the end of the common bile duct and duodenal papilla, ampulla and other benign and malignant diseases. It is one of the most challenging operations in abdominal surgery. Although great progress has been made in the field of pancreatic surgery in recent years, the surgical technique has been improved and the nursing level has been improved, the mortality rate of this operation has been reduced to about 5%, however, the incidence of postoperative complications is still as high as 30%. Among them, pancreatic fistula is one of the most common and dangerous complications. The purpose of this study was to investigate the value of continuous Prolene line anastomosis of pancreatic duct and jejunum in pancreaticojejunostomy. Methods: the clinical data of 165 patients undergoing pancreaticoduodenectomy in the Department of Hepatobiliary surgery of the fourth Hospital of Hebei Medical University from June 2013 to June 2015 were retrospectively analyzed. Among them, 53 cases underwent consecutive pancreaticojejunal mucosal Prolene line anastomosis. 112 cases of common nested pancreaticojejunostomy were used. To compare the incidence of pancreatic fistula between the two groups. Statistical analysis was carried out with SPSS 21.0 software package. 蠂 2 test was used for statistical analysis. Results: of the 165 patients undergoing pancreaticoduodenectomy, 69 had postoperative complications (41.8%). The main complications were abdominal infection in 36 cases (21. 8%), pancreatic fistula in 19 cases, duodenal hemorrhage in 17 cases and pancreatic fistula in 19 cases. The incidence rate was 10.3% and 2 cases died during operation (mortality 1.2%). There were only 2 cases of pancreatic fistula in 53 patients who underwent continuous anastomosis of jejunal Prolene line, all of which were grade A. The pancreatic fistula disappeared and the incidence of pancreatic fistula was 3.810 / 53 after symptomatic treatment, and 112 cases were treated with common nested pancreaticojejunostomy. There were 17 cases of pancreatic fistula after operation, and the incidence of pancreatic fistula was 15.2R / 17 / 112%. There was a significant difference between the two groups (蠂 ~ (2) 4.493) (蠂 ~ (2) 4.493) (P ~ (0.037). Conclusion: the technique of continuous anastomosis of Prolene line of jejunal mucosa of pancreatic duct is to adopt continuous anastomosis of the main pancreatic duct and the whole layer of jejunum. The anastomosis is accurate, the pancreatic fistula is not easy to occur, the influence of pancreatic texture is small, and the Prolene needle and thread are integrated, the line body is smooth, and the friction force is small. Suitable for continuous anastomosis. This anastomosis method is convenient and feasible, and can significantly reduce the incidence of pancreatic fistula. It is a safe and feasible anastomosis method.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R656.64

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