不同胰—空肠吻合方式对胰十二指肠切除术后胰瘘发生的影响

发布时间：2018-07-28 11:45

【摘要】：目的：通过分析胰十二指肠切除术(PD)中不同的胰腺-空肠吻合方式对术后胰肠吻合口瘘的发生率,探究合理的胰肠吻合方式对预防PD术后胰肠吻合口瘘的重要性。方法：回顾性分析2009年1月到2014年1月在兰州大学第一医院普通外科施行胰十二指肠切除术115例患者的基本资料,根据胰腺-空肠吻合方式将患者分为3组：套入吻合组(A组)45例,行套入式胰腺-空肠吻合；黏膜吻合组(B组)54例,行胰管-空肠黏膜端侧吻合；浆肌层吻合组(C组)16例,行胰腺-空肠浆肌层吻合,比较3组患者术后的胰肠吻合口瘘发生率。应用统计学软件SPSS 21统计学分析,对围手术期出现胰肠吻合口瘘的相关性因素进行分析。结果：115例患者PD术后出现胰肠吻合口瘘20例,胰肠吻合口瘘总的发生率是17.4%(20/115),其中套入吻合组10例,占22.2%(10/45)；黏膜吻合组4例,占7.4%(4/54)；浆肌层吻合组6例,占37.5%(6/16)。3组患者的胰肠吻合口瘘发生率不全相同(χ2=8.891,P=0.011)。胰肠吻合口瘘发生率在胰腺空肠套入吻合组与胰管-空肠黏膜吻合组间差异显著(P=0.049,95%可信区间0.00-0.30),胰管-空肠黏膜吻合组与胰腺-空肠浆肌层吻合组间差异同样显著(P=0.005,95%可信区间-0.51～-0.09),胰腺-空肠套入吻合组与胰腺-空肠浆肌层吻合组间差异无统计学意义(P=0.157,95%可信区间-0.37--0.06)。单因素分析结果显示性别、年龄、术前营养状况、黄疸程度、是否有糖尿病、胰管直径、胰腺质地、疾病类型等对PD术后胰肠吻合口瘘的关系不密切(P0.05),胰腺-空肠吻合方法是胰十二指肠切除术后胰肠吻合口瘘的独立危险因素。结论：良好的胰腺-空肠吻合技术是防止PD术后胰肠吻合口瘘发生的重要保障,胰管-空肠黏膜吻合操作简便,胰肠吻合口瘘发生率低,建议采用。
[Abstract]:Objective: to explore the importance of reasonable pancreaticojejunostomy in preventing pancreaticojejunostomy fistula after pancreaticoduodenectomy by analyzing the incidence of pancreaticojejunostomy in (PD). Methods: from January 2009 to January 2014, 115 patients underwent pancreatoduodenectomy in the first Hospital of Lanzhou University were analyzed retrospectively. Patients were divided into three groups according to pancreato-jejunostomy: group A (45 cases), group B (54 cases), group C (16 cases). The incidence of pancreaticojejunostomy fistula in 3 groups was compared. The correlation factors of pancreaticojejunostomal fistula in perioperative period were analyzed by SPSS 21 software. Results the total incidence of pancreaticojejunostomy fistula was 17.4% (20 / 115) in 115 cases of PD, including 10 cases (22. 2%) in the anastomosis group, 4 cases (7. 4%) in the mucosal anastomosis group, 6 cases in the sarcoplasmic myostomy group, 4 cases in the mucosal anastomosis group, and 6 cases in the sarcoplasmic myostomy group. The incidence of pancreaticojejunostomal fistula in 37.5% (6 / 16) group was not the same (蠂 ~ (2 +) 8.891g / P ~ (0.011). The incidence of pancreaticojejunostomy fistula was significantly different between the pancreatic jejunostomy group and the pancreatic duct jejunal mucosa anastomosis group (P 0.049 95% confidence interval 0.00-0.30). The difference was also significant between the pancreatic duct and jejunal mucosa anastomosis group and the pancreatic jejunal muscular layer anastomosis group. There was no significant difference between the pancreatic jejunostomy group and the pancreaticojejunal muscular layer anastomosis group (P < 0.157 ~ 95% confidence interval -0.37 ~ 0.06). Univariate analysis showed that sex, age, preoperative nutritional status, degree of jaundice, diabetes, pancreatic duct diameter, pancreatic texture, The type of disease was not closely related to pancreaticojejunostomy fistula after PD (P0.05). Pancreaticojejunostomy was an independent risk factor for pancreaticojejunostomy fistula after pancreaticoduodenectomy. Conclusion: good technique of pancreaticojejunostomy is an important guarantee to prevent pancreaticojejunostomy fistula after PD. The operation of pancreaticojejunostomy is simple and the incidence of pancreaticojejunostomy fistula is low.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R656

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