U型套入式端侧胰肠吻合的临床应用

发布时间：2019-03-01 16:39

【摘要】：目的:探讨U型套入式端侧胰肠吻合技术在胰十二指肠切除术中应用的安全性和实用性。方法:回顾性分析2008年09月至2016年09月于延边大学附属医院行胰十二指肠切除术的163例患者的临床资料,根据胰肠吻合方式的不同分为三组:胰管空肠黏膜对黏膜吻合组(A组)28例、空肠腔内无胰断端裸露的胰肠吻合组(B组)90例和U型套入式端侧胰肠吻合组(C组)45例(包括1例腹腔镜下胰肠吻合)。比较分析三组胰瘘相关的危险因素、主要并发症的发生率、吻合时间及术后住院时间差异。结果:三组间胰瘘相关危险因素比较无统计学差异。三组间胰瘘发生率比较差异有统计学意义(A组:32.1%,B组3.3%,C组2.2%,P0.001);临床胰瘘(B+C级)三组间比较有统计学差异(A组:17.9%,B组:2.2%,C组:0%,P0.001):与B组相比,A组高于B组,差异有统计学意义(P=0.0080.0167);A组与C组相比,差异有统计学意义(P=0.0070.0167),C组低于A组;而B组和C组则差异无统计学意义(P=0.5520.0167)。其它非胰瘘主要并发症(胃排空延迟、胆瘘等)三组间比较无统计学差异.(P0.05)。比较三组胰肠吻合时间,差异具有显著的统计学意义(A组29.1±2.6 min,B组25.1±2.6 min,C组13.6±2.4 min,P＜0.001):A组吻合时间高于B组和C组(P0.001,),B组吻合时间高于C组(P0.001);三组间术后住院时间差异未见统计学意义。结论:U型套入式端侧胰肠吻合技术安全实用,可有效降低术后临床胰瘘发生率;吻合时间短,操作简单,易于掌握;可适用于腹腔镜下胰十二指肠切除术时的胰肠吻合。
[Abstract]:Objective: to evaluate the safety and practicability of U-type inserted end-to-side pancreaticojejunostomy in pancreaticoduodenectomy. Methods: the clinical data of 163 patients undergoing pancreaticoduodenectomy in the affiliated Hospital of Yanbian University from September 2008 to September 2016 were retrospectively analyzed. According to the different ways of pancreaticojejunostomy, they were divided into three groups: pancreatic duct-jejunum mucosa-to-mucosa anastomosis group (group A), 28 cases. There were 90 cases in group B (n = 90) and 45 cases (group C) in group C (including 1 case under laparoscopic pancreaticojejunostomy) without denudation of pancreaticojejunostomy without pancreaticojejunostomy (group B) and U-type nested end-to-side pancreatojejunostomy (group C). The risk factors related to pancreatic fistula, the incidence of major complications, the duration of anastomosis and postoperative hospital stay were compared and analyzed among the three groups. Results: there was no significant difference in the risk factors of pancreatic fistula among the three groups. There was a significant difference in the incidence of pancreatic fistula among the three groups (group A: 32.1%, group B 3.3%, group C 2.2%, P0.001). There were statistical differences among three groups (group A: 17.9%, group B: 2.2%, group C: 0%, P0.001): compared with group B, group A was significantly higher than group B (P < 0.001). There was a significant difference between group A and group C (P < 0. 0070.0167), C), but there was no significant difference between group B and group C (P < 0. 5520.0167). Other major complications of non-pancreatic fistula (delayed gastric emptying, biliary fistula, etc.) there was no significant difference among the three groups (P0.05). There was a significant difference in the time of pancreaticointestinal anastomosis among the three groups (29.1 卤2.6min,P, 25.1 卤2.6min,P, 13.6 卤2.4min,P < 0.001): A, group A: 29.1 卤2.6min,P < 0.001): A, P 0.001, P < 0.001, P < 0.01, P < 0.05). The anastomosis time in), B group was longer than that in C group (P0.001). There was no significant difference in postoperative hospitalization time among the three groups. Conclusion: the technique of U-type inserted end-to-side pancreaticojejunostomy is safe and practical, can effectively reduce the incidence of postoperative pancreatic fistula, the anastomosis time is short, the operation is simple and easy to master, and it can be applied to pancreaticojejunostomy during laparoscopic pancreaticoduodenectomy.
【学位授予单位】：延边大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R656

【参考文献】