胰十二指肠切除术中不同胰肠吻合方式对术后并发症的影响

发布时间：2018-05-14 08:56

  本文选题：胰十二指肠切除术 + 胰瘘　； 参考：《浙江大学》2015年博士论文

【摘要】：目的 胰腺癌早期没有明显的临床症状,不易发现,且胰腺癌病程进展快,临床上确诊是往往已是中晚期,手术难以完全切除,术后预后较差。胰十二指肠切除术(pancreaticoduodenectomy, PD)是目前胰腺癌的主要治疗手段,关于胰肠吻合方式与术后并发症的研究,目前相关文献报道多为单中心回顾性研究,前瞻性研究都是多中心的,手术者的技术水平对研究结果有一定的偏倚影响,难以评价不同手术方式的优劣。本论文旨在通过单中心的前瞻性的研究,比较套入式和胰管-粘膜吻合方式对PD术后并发症的影响。 方法 研究入组对象为2012年10月2015年3月期间所有因胰腺癌、胆管癌和壶腹癌等于浙江大学医院附属第二医院行胰十二指肠切除术的患者,由同一医疗小组(浙二外五病区)同一主刀医生主刀行胰十二指肠切除术治疗,主要研究终点：胰瘘,其发生和等级标准按照国际胰瘘研究小组ISGPF标准,次要研究终点：围手术期死亡、并发症、再手术、术后住院日、再入院。本研究还对胰瘘的风险因素进行了探索。 结果 共纳入患者132例,采用胰腺-空肠套入式吻合68例(套入组),采用胰管-空肠黏膜吻合64例(胰管-粘膜组)。围手术期套入组死亡1人,胰管-粘膜组无死亡,P=1.000,术后总体并发症发生率为51.5%,两组并发症的发生概率分别为55.9%vs46%,P=0.301。套入组的并发症严重程度明显高于胰管-粘膜组(Ⅲ级以上并发症：P=0.013)。总体术后胰瘘发生率为29.5%,临床相关性胰瘘(CR-PF)发生率为10.6%,套入组与胰管-粘膜组术后胰瘘发生率分别为30.9%vs.28.5%,P=0.729,但两种在胰瘘等级分布上有显著差异(P=0.004),套入组CR-PF多。中值术后住院天数分别为15天、13天(P=0.021),套入组的住院时间更长。胰腺质地硬的患者PF发生率低(P=0.013)。胰管直径,病理类型及性别是PF独立的风险因素。结论 胰管对空肠套入式吻合和胰管-粘膜吻合方式相比,术后并发症发生的概率并没有明显的差异。套入式吻合比胰管-粘膜吻合的术后并发症更严重,且术后住院时间更长。
[Abstract]:Purpose There are no obvious clinical symptoms in early stage of pancreatic cancer, which are difficult to find, and the course of pancreatic cancer is rapid, the diagnosis is usually in the middle and late stage, the operation is difficult to be completely resected, and the prognosis is poor. Pancreaticoduodenectomy (PDD) is the main treatment for pancreatic cancer at present. The study of pancreaticojejunostomy and postoperative complications is mostly monocentric and prospective studies. The technical level of the patients has a certain bias to the results of the study, it is difficult to evaluate the advantages and disadvantages of different surgical methods. The purpose of this study was to compare the effects of intra-and pancreatic duct-mucosal anastomosis on the postoperative complications of PD by a single-center prospective study. Method The study included all patients with pancreatic cancer, cholangiocarcinoma and ampullary carcinoma who underwent pancreaticoduodenectomy in the second affiliated Hospital of Zhejiang University Hospital during October 2012 and March 2015. Pancreaticoduodenectomy was performed by the same medical team (Zhejiang No. 2, No. 5) and the same surgeon. The main endpoints were: pancreatic fistula. The occurrence and grade of pancreatic fistula were according to the ISGPF standard of international pancreatic fistula research group. Secondary study endpoint: perioperative death, complications, re-operation, postoperative hospitalization, re-admission. The risk factors of pancreatic fistula were also explored. Result A total of 132 patients were included in this study. 68 cases were treated with pancreaticojejunostomy and 64 cases with pancreatic duct-jejunal mucosal anastomosis (pancreaticojejunostomy). One patient died in the perioperative period and there was no death in the pancreatic duct mucosa group. The overall incidence of postoperative complications was 51.5. The probability of complications in the two groups was 55.9 vs 46 and P 0.301 respectively. The severity of complications in the intratuminal group was significantly higher than that in the pancreatic duct-mucosal group (> grade 鈪，

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