胰十二指肠切除术不同胰肠吻合方式术后并发症分析

发布时间：2018-08-26 16:28

【摘要】：目的:胰十二指肠切除术(pancreaticoduodenectomy,PD)为肝胆胰外科手术中难度较高的手术之一,其术后出现胰瘘、出血、胆瘘、腹腔感染等并发症后,结局往往是灾难性的。所以,自术式创建以来,外科医生一直在探究如何通过改进手术方式,尤其是胰肠吻合方式来预防并发症的发生。本文收集118例行胰十二指肠切除术病例进行回顾性分析,旨在比较不同胰肠吻合方式对术后并发症的影响,并且对胰瘘的相关风险因素进行进一步探索。方法:病例选取2010年1月-2016年7月共118例在吉林大学第一医院肝胆胰外科行胰头十二指肠切除术的患者。吻合方式为胰管空肠端侧黏膜-黏膜吻合(粘膜组)、胰肠端侧套入式吻合(端侧组)、胰肠端端套入式吻合(端端组)、捆绑式胰肠套入式吻合(捆绑组)。对术前因素、术中因素、术后因素进行统计学分析。结果:各种吻合方式在术后并发症比较,总体无统计学差异(P0.05)。粘膜组相较其他3组,手术时间最长(5.86±1.18h),术中出血量最多(538.57±392.22ml)。胰管直径、性别及胰腺质地为胰瘘独立风险因素。结论:不同吻合方式对预防术后并发症发生率均无明显优势。更多取决于术者的技巧及依术中情况对术式选择的综合把控。
[Abstract]:Objective: Pancreatoduodenectomy (PD) is one of the most difficult operations in hepatobiliary and pancreatic surgery. The outcome is often disastrous after pancreatic fistula, hemorrhage, biliary fistula, abdominal infection and other complications. Methods: 118 cases of pancreaticoduodenectomy from January 2010 to July 2016 were retrospectively analyzed to compare the effects of different pancreaticoduodenectomy methods on postoperative complications and to explore the risk factors of pancreatic fistula. Pancreatojejunal mucosa-mucosa anastomosis (mucosa group), end-to-side pancreaticojejunostomy (end-to-side group), end-to-end pancreaticojejunostomy (end-to-end group), end-to-end pancreaticoduodenal anastomosis (end-to-end group), and bundled pancreaticoduodenal anastomosis (bundled group) were performed in the hepatobiliary and pancreatic surgery department of the First Hospital of Jilin University. Results: There was no significant difference in postoperative complications among different anastomosis methods (P 0.05). Compared with the other three groups, the mucosa group had the longest operation time (5.86 (+ 1.18 h) and the most intraoperative bleeding volume (538.57 (+ 392.22 ml). The diameter of pancreatic duct, sex and pancreatic texture were independent risk factors for pancreatic fistula. There is no obvious advantage in preventing postoperative complications. It depends more on the skill of the operator and the comprehensive control of the choice of operation according to the operation conditions.
【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

【相似文献】