胰十二指肠切除术后胰管支撑管内引流及外引流的疗效比较

发布时间：2018-12-27 16:19

【摘要】：目的：胰十二指肠切除术(pancreaticoduodenectomy, PD)亦称Whipple手术，是治疗胰头癌、壶腹周围癌的主要方法。PD术后胰瘘一直是胰腺外科医生永恒的话题，而胰瘘也是促进PD不断改进、不断发展的主要动力之一。为了预防胰瘘，外科医生从未停止探索的脚步，从吻合方式、吻合技巧、缝线、生物蛋白胶、胰管支撑管到各种支持药物的使用等各个环节都在不断的努力，目的是降低胰瘘及其他术后相关并发症的发生率。胰管支撑管应用于临床具有重大的意义，但对于胰管支撑管的内引流与外引流何者能更有效的预防胰瘘，，各医学中心和学者尚未达成一致观点。目前对于胰管支撑管的内引流与外引流以何种方式更确切，国内外相关文献报道较少。通过分析本组病例资料，比较胰十二指肠切除术后胰管支撑管的内引流与外引流对于术后胰瘘及其他术后并发症发生的影响，来探讨胰管支撑管的内引流与外引流在预防胰瘘中的价值。方法：回顾性分析吉林大学中日联谊医院2010年10月至2014年2月期间施行PD的病例资料107例，其中未使用支撑管18例、胰胃吻合5例排除此次研究，纳入观察组共84例，内引流49例（58.3%），外引流35例（41.7%）。所有患者均接受PD，并均在胰管内置入与其口径相当的支撑管。分别分析患者术前指标（年龄、性别、黄疸时间、高血压、心脏病、糖尿病、总胆红素、直接胆红素、间接胆红素、总蛋白、白蛋白、血红蛋白测定）、术中指标（疾病组成、吻合方式、胰腺质地、胰管直径）、术后指标（胆瘘、胃肠/肠肠吻合口瘘、消化道内出血、肺部并发症、切口感染、二次手术、生长抑素的使用、术后死亡、住院时间）的差异，来比较支撑管内引流与外引流对于术后胰瘘的影响。结果：患者术前指标（年龄、性别、黄疸时间、高血压、心脏病、糖尿病、总胆红素、直接胆红素、间接胆红素、总蛋白、白蛋白、血红蛋白测定）、术中情况（疾病组成、胰腺质地、胰管直径、吻合方式）、术后情况（胆瘘、胃肠/肠肠吻合口瘘、消化道内出血、肺部并发症、切口感染、二次手术、生长抑素的使用、术后死亡、住院时间）等指标均无统计学差异。内引流组发生胰瘘12例（24.5%），外引流组发生胰瘘2例（5.7%），差异有统计学意义（P=0.023）。结论：胰管支撑管外引流在预防胰瘘上优于内引流。
[Abstract]:Objective: pancreaticoduodenectomy (pancreaticoduodenectomy, PD), also known as Whipple's operation, is the main method for the treatment of pancreatic head cancer and periampullary carcinoma. Pancreatic fistula after PD is always an eternal topic for pancreatic surgeons, and pancreatic fistula also promotes the improvement of PD. One of the main driving forces of continuous development. In order to prevent pancreatic fistula, surgeons have never stopped exploring everything from anastomosis, anastomosis techniques, sutures, bioprotein glue, pancreatic duct support tubes to the use of various support drugs. Objective to reduce the incidence of pancreatic fistula and other postoperative complications. The clinical application of pancreatic duct support tube is of great significance, but there is no consensus among medical centers and scholars on which internal and external drainage of pancreatic duct support tube can prevent pancreatic fistula more effectively. At present, there are few reports about the internal and external drainage of the pancreatic duct. By analyzing the data of this group of patients, the effects of internal and external drainage of pancreatic duct supporting tube on pancreatic fistula and other postoperative complications after pancreaticoduodenectomy were compared. To explore the value of internal and external drainage of pancreatic duct supporting duct in preventing pancreatic fistula. Methods: the data of 107 cases of PD from October 2010 to February 2014 in Jilin University Sino-Japanese Friendship Hospital were retrospectively analyzed, including 18 cases without supporting tube, 5 cases with pancreaticogastric anastomosis excluded from the study, and 84 cases in observation group. There were 49 cases (58.3%) with internal drainage and 35 cases (41.7%) with external drainage. All patients received PD, and were placed in the pancreatic duct with a supporting tube equivalent to their caliber. The preoperative indexes (age, sex, time of jaundice, hypertension, heart disease, diabetes mellitus, total bilirubin, direct bilirubin, indirect bilirubin, total protein, albumin, hemoglobin) were analyzed respectively. Anastomosis, pancreatic texture, diameter of pancreatic duct, postoperative parameters (biliary fistula, gastrointestinal / intestinal anastomotic fistula, gastrointestinal bleeding, pulmonary complications, incision infection, secondary surgery, use of somatostatin, postoperative death, To compare the effect of supporting tube drainage and external drainage on postoperative pancreatic fistula. Results: preoperative parameters (age, sex, time of jaundice, hypertension, heart disease, diabetes mellitus, total bilirubin, direct bilirubin, indirect bilirubin, total protein, albumin, hemoglobin), intraoperative condition (disease composition), Pancreatic texture, pancreatic duct diameter, anastomosis mode, postoperative conditions (biliary fistula, gastrointestinal / intestinal anastomotic fistula, gastrointestinal bleeding, pulmonary complications, incision infection, secondary surgery, use of somatostatin, postoperative death, There was no statistical difference in the duration of hospitalization. Pancreatic fistula occurred in 12 cases (24.5%) in the internal drainage group and in 2 cases (5.7%) in the external drainage group. The difference was statistically significant (P0. 023). Conclusion: the external drainage of pancreatic duct supporting tube is superior to internal drainage in preventing pancreatic fistula.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.5

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