胰体尾切除术中胰腺残端不同处理方式的对比分析

发布时间：2018-06-18 17:54

本文选题：胰体尾切除术 + 闭合器　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]探讨胰体尾切除术中关于胰腺残端不同处理方式的优劣,重点分析不同处理方式与术后胰瘘的关系,旨在探讨胰腺残端何种处理方式更为合理。[方法]回顾性分析2003年-2016年昆明医科大学第一附属医院74例(包括外伤、结石及肿瘤等)行胰体尾切除术的患者临床资料。1.首先分析患者胰腺质地的软硬、入院前是否伴有明显临床症状及术前是否伴有慢性胰腺炎对于胰瘘有何影响;2.再根据术中对其胰腺残端不同的处理方式分为四组:(1)单纯使用切割闭合器组17例(后文统称为单纯闭合器组);(2)单纯手工缝合组19例(后文统称为手工缝合组);(3)联合使用单纯闭合器及手工缝合组22例(后文统称为联合组);(4)胰肠吻合组16例。先对所有患者的入院主诉是否有明显症状(如腹痛、恶心呕吐、黄疸等)、术前是否伴发慢性胰腺炎及胰腺质地与胰瘘的关系进行分析,再分别分析以下几点的差异:(1)各组患者的一般情况(如性别比例、年龄、体质指数);(2)术后胰瘘率;(3)术中出血量;(4)手术时间;(5)术后住院时间;(6)住院总花费。[结果]1.术前一般情况与胰瘘的关系:(1)各组患者在性别比例、年龄、体质指数方面均无明显差异;(2)入院前主诉有明显症状者术后胰瘘率34.37%,入院前无明显症状者术后胰瘘率45.24%,P=0.474,二者差异无统计学意义;(3)胰腺质地较软者术后胰瘘率51.62%,质地较硬者术后胰瘘率25.81%,P=0.033,二者差异有统计学意义;(4)术前伴发有慢性胰腺炎者术后胰瘘率24.13%,无慢性胰腺炎者术后胰瘘率51.11%,P=0.029,二者差异有统计学意义;2.胰腺残端处理方式与胰瘘的关系:单纯闭合器组、手工缝合组、联合组和胰肠吻合组分别为:70.59%,31.57%,31.82%,31.25%,其中手工缝合组、联合组及胰肠吻合组胰瘘率低于单纯闭合器组,差异有统计学意义,而手工缝合组、联合组及胰肠吻合组差异无统计学意义;3.在术中出血量方面四组分别为:150.18±24.49ml,153.94 ± 14.29ml,155.38±32.59ml,153.68±35.24ml,无明显差异;4.在手术时间上胰肠吻合组(232.50±33.37min)高于手工缝合组(194.95±33.82min),手工缝合组又要高于联合组(161.36±29.89min)与单纯闭合器组(167.65±34.15min),联合组与单纯闭合器组则无明显差异;5.在术后住院时间上四组分别:12.06±2.95d,12.05±3.15d,10.73±2.51d,14.69±3.03d,胰肠吻合组明显高于其他三组,而其他三组无明显差异;6.在住院总费用上手工缝合组最低(4.01 ±.088万元),单纯闭合器组(5.14±0.90万元)与联合组(4.66±0.68万元)无明显差异,而胰肠吻合组最高(5.69±0.87 万元);[结论]1.四组患者在性别比例、年龄、体质指数方面并无明显差异,具有临床可比性;入院前是否伴明显症状与术后胰瘘并无明显关系;胰腺质地较软者术后更易发生胰瘘;术前并发有慢性胰腺炎者术后不易发生胰瘘;2.不同处理方式对比分析:(1)在术后胰瘘方面,单纯闭合器组手工缝合组=联合组=胰肠吻合组,故不建议单纯使用切割闭合器处理保留的胰腺残端;(2)在术中出血量方面,四组并无明显差异;(3)在手术时间上,胰肠吻合组手工缝合组联合组=单纯闭合器组。过长的手术时间有可能会增加术中相关并发症发生的几率;(4)在术后住院时间上胰肠吻合组明显高于其他三组,而其他三组无明显差异。过长的住院时间一方面会加大患者的心理压力,另一方面也会产生更多的费用;(5)在住院总费用上,胰肠吻合组联合组=单纯闭合器组手工缝合组。综上所述在实际操作过程中,临床工作者应综合考虑患者患者实际情况决定使用何种方法。
[Abstract]:[Objective] to discuss the advantages and disadvantages of different treatment methods of pancreatic stump during the caudal pancreatectomy, and to analyze the relationship between different treatment methods and postoperative pancreatic fistula. The purpose of this study is to explore the way of treatment of pancreatic stump. [Methods] 74 cases (including trauma, calculi and tumor) in the First Affiliated Hospital of Kunming Medical University in 2003 were retrospectively analyzed. The clinical data of the patients with pancreatic caudectomy.1. first analyzed the soft and hard pancreatic texture of the patients, whether there were obvious clinical symptoms before admission and whether there was any effect of chronic pancreatitis on the pancreatic fistula before the operation. 2., four groups were divided according to the different treatment methods of the pancreatic stump during the operation: (1) 17 cases were simply used in the incision and closure group. The latter was referred to as the simple closure group; (2) 19 cases in the simple manual suture group (after the hand suture group); (3) the combined use of simple closure and manual suture group 22 cases (after the combined group); (4) 16 cases of pancreatic intestinal anastomosis group. First, the admission of all patients has obvious symptoms (such as abdominal pain, nausea nausea, jaundice, etc.), before operation is Analysis of the relationship between chronic pancreatitis and pancreatic texture and pancreatic fistula: (1) general conditions (such as sex ratio, age, body mass index); (2) postoperative pancreatic fistula rate; (3) intraoperative bleeding; (4) hand operation time; (5) postoperative hospitalization time; (6) general hospitalization expenses. [results]1. general conditions before operation) The relationship with pancreatic fistula: (1) there was no significant difference in sex ratio, age and body mass index in all groups; (2) the rate of pancreatic fistula after admission was 34.37%, the rate of pancreatic fistula was 45.24% after admission without obvious symptoms, and there was no significant difference between two and two. (3) the rate of pancreatic fistula after surgery was 51.62% and the quality of the pancreas was hard. The postoperative pancreatic fistula rate was 25.81%, P=0.033, and two differences were statistically significant; (4) the rate of pancreatic fistula with chronic pancreatitis was 24.13%, the rate of pancreatic fistula was 51.11%, P=0.029 without chronic pancreatitis, and the difference between the two were statistically significant; 2. the relationship between the pancreatic stump treatment and the pancreatic fistula: the simple closure group, the manual suture group, the combined group and the pancreas The intestinal anastomosis group were 70.59%, 31.57%, 31.82%, 31.25% respectively. The rate of pancreatic fistula in the group of manual suture group, the combined group and the pancreas enterostomy group was lower than that of the simple closure group, and the difference was statistically significant. The difference between the manual suture group, the combined group and the pancreas enterostomy group was not statistically significant. 3. the four groups in the intraoperative bleeding were 150.18 + 24.49ml, 153.94 + 14. .29ml, 155.38 + 32.59ml, 153.68 + 35.24ml, no significant difference. 4. in the operation time, the group of pancreatic and intestinal anastomosis (232.50 + 33.37min) was higher than that of the manual suture group (194.95 + 33.82min), and the manual suture group was higher than the combined group (161.36 + 29.89min) and the simple closure group (167.65 + 34.15min), and there was no significant difference between the combined group and the simple closure group; 5. in the operation. After hospitalization, the four groups were 12.06 + 2.95d, 12.05 + 3.15d, 10.73 + 2.51d, 14.69 + 3.03d, and the pancreatic intestinal anastomosis group was significantly higher than the other three groups, while the other three groups were not significantly different; 6. in the total hospitalization cost was the lowest (4.01 +.088 million yuan), and the simple closure group (5.14 + 9 thousand yuan) and the United Group (4.66 + 6 thousand and 800 yuan) had no significant difference. There was no significant difference in sex ratio, age and body mass index in group]1. four patients (5.69 + 8 thousand and 700 yuan). [Conclusion] there was no significant difference in sex ratio, age and body mass index. It was not easy to have pancreatic fistula; 2. the comparison and analysis of different treatment methods: (1) in the postoperative pancreatic fistula, the simple closure group hand suture group = combined group = Pancreaticoenterostomy group, so it is not recommended to simply use the cutting closure to treat the retained pancreatic stump; (2) there is no significant difference between the four groups in the amount of bleeding during the operation; (3) in the operation time, the Pancreaticoenterostomy group hand The combined group of the suture group = the simple closure group. The long operation time may increase the probability of the associated complications in the operation; (4) the group of pancreatic and intestinal anastomosis in the postoperative hospital time is obviously higher than the other three groups, while the other three groups have no significant difference. (5) in the total cost of hospitalization, the joint group of the group of Pancreaticoenterostomy = the manual suture group of the simple closure group. To sum up, in the actual operation, the clinical worker should consider what the patient's patient's actual situation decides to use.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.5

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