中华胰腺病杂志
中華胰腺病雜誌
중화이선병잡지
CHINESE JOURNAL OF PANCREATOLOGY
2011年
2期
107-109
,共3页
李建国%卢燕辉%陈宇峰%林志川%江小杰%许晨晖
李建國%盧燕輝%陳宇峰%林誌川%江小傑%許晨暉
리건국%로연휘%진우봉%림지천%강소걸%허신휘
外科手术%胰十二指肠切除术%回顾性研究
外科手術%胰十二指腸切除術%迴顧性研究
외과수술%이십이지장절제술%회고성연구
Surgical procedures,operative%Pancreaticoduodenectomy(PD)%Retrospective studies
目的 探讨不同时段胰十二指肠切除术(PD)手术方式的演变及其意义.方法 回顾分析1988年至2008年福建漳州市医院普外科行PD的165例患者资料.其中行单纯PD 138例,行保留幽门的PD(PPPD)14例,行扩大PD 13例.PD残胰重建方式:捆绑式胰空肠吻合(彭Ⅰ式)68例,胰胃吻合61例,传统的胰空肠吻合30例,孔式的胰空肠黏膜对黏膜吻合6例.结果 1988年至1998年(前10年)行PD 50例,其中单纯PD 42例、PPPD 8例,无扩大的PD;术中平均出血(620±180)ml,平均输血(530±120)ml,平均手术时间(6.5±3.5)h;吻合口瘘发生率14.0%(7/50),围手术期病死率4.0%(2/50).1999年至2008年(后10年)行PD 115例,其中单纯PD 96例、PPPD 6例、扩大的PD 13例;术中平均出血(360±110)ml,平均输血(400±60)m],平均手术时间(3.0±2.5)h;吻合口瘘发生率3.5%(4/115),围手术期病死率0.9%(1/115).术后109例得到6个月~5年随访,1、3、5年生存率分别为87.2%(95/109)、54.1%(59/109)和39.5%(43/109).结论 后10年PD的术中出血量、手术时间、胰瘘发生率和病死率均较前10年显著下降.
目的 探討不同時段胰十二指腸切除術(PD)手術方式的縯變及其意義.方法 迴顧分析1988年至2008年福建漳州市醫院普外科行PD的165例患者資料.其中行單純PD 138例,行保留幽門的PD(PPPD)14例,行擴大PD 13例.PD殘胰重建方式:捆綁式胰空腸吻閤(彭Ⅰ式)68例,胰胃吻閤61例,傳統的胰空腸吻閤30例,孔式的胰空腸黏膜對黏膜吻閤6例.結果 1988年至1998年(前10年)行PD 50例,其中單純PD 42例、PPPD 8例,無擴大的PD;術中平均齣血(620±180)ml,平均輸血(530±120)ml,平均手術時間(6.5±3.5)h;吻閤口瘺髮生率14.0%(7/50),圍手術期病死率4.0%(2/50).1999年至2008年(後10年)行PD 115例,其中單純PD 96例、PPPD 6例、擴大的PD 13例;術中平均齣血(360±110)ml,平均輸血(400±60)m],平均手術時間(3.0±2.5)h;吻閤口瘺髮生率3.5%(4/115),圍手術期病死率0.9%(1/115).術後109例得到6箇月~5年隨訪,1、3、5年生存率分彆為87.2%(95/109)、54.1%(59/109)和39.5%(43/109).結論 後10年PD的術中齣血量、手術時間、胰瘺髮生率和病死率均較前10年顯著下降.
목적 탐토불동시단이십이지장절제술(PD)수술방식적연변급기의의.방법 회고분석1988년지2008년복건장주시의원보외과행PD적165례환자자료.기중행단순PD 138례,행보류유문적PD(PPPD)14례,행확대PD 13례.PD잔이중건방식:곤방식이공장문합(팽Ⅰ식)68례,이위문합61례,전통적이공장문합30례,공식적이공장점막대점막문합6례.결과 1988년지1998년(전10년)행PD 50례,기중단순PD 42례、PPPD 8례,무확대적PD;술중평균출혈(620±180)ml,평균수혈(530±120)ml,평균수술시간(6.5±3.5)h;문합구루발생솔14.0%(7/50),위수술기병사솔4.0%(2/50).1999년지2008년(후10년)행PD 115례,기중단순PD 96례、PPPD 6례、확대적PD 13례;술중평균출혈(360±110)ml,평균수혈(400±60)m],평균수술시간(3.0±2.5)h;문합구루발생솔3.5%(4/115),위수술기병사솔0.9%(1/115).술후109례득도6개월~5년수방,1、3、5년생존솔분별위87.2%(95/109)、54.1%(59/109)화39.5%(43/109).결론 후10년PD적술중출혈량、수술시간、이루발생솔화병사솔균교전10년현저하강.
Objective To investigate the evolution of pancreaticoduodenectomy and its significance in different time periods. Methods The clinical data of 165 patients from 1988 to 2008 in the department of general surgery, Zhangzhou Municipal Hospital with pancreaticoduodenectomy were retrospectively analyzed.Among 165 cases, simple pancreatoduodenectomy (PD) were performed in 138 cases, pylorus preserving pancreatoduodenectomy (PPPD) were performed in 14 cases, and extended pancreaticoduodenectomy were performed in 13 cases. The methods of pancreato-enteric reconstruction in pancreaticoduodenectomy included 68 cases with binding pancreaticojejunostomy (Peng's type Ⅰ ); 61 cases with pancreaticogastrostomy; 30 cases with traditional pancreaticojejunostomy; and 6 cases with duct-to-mucous pancreaticojejunostomy.Results From 1988 to 1998 (the first 10 years), 50 patients underwent pancreaticoduodenectomy, including 42 cases of PD and 8 cases of PPPD, and no case of extended pancreaticoduodenectomy. The mean amount of blood loss was (620 ± 180)ml, mean amount of blood transfusion was (530 ± 120)ml, the mean operation time was (6.5 ±3.5)h. Anastomotic fistula occurred in 7 cases, the incidence of anastomotic fistula was 14.0%(7/50); and 2 cases died during perioperative period with a mortality rate of 4.0% (2/50). From 1999 to 2008 (the latter 10 years), 115 patients underwent pancreaticoduodenectomy, including 96 cases of PD, 6 cases of PPPD, and 13 cases of extended PD. The mean amount of blood loss was (360 ± 110)ml, mean amount of blood transfusion was (400 ± 6 ) ml, the mean operation time was ( 3.0 ± 2.5 ) h, Anastomotic fistula occurred in 4 cases with an incidence of 3.5% ( 4/115 ); and one case during perioperative period with a mortality rate of 0.61%. The postoperative follow up time was ranging from 6 months to 5 years in 109 patients, the 1, 3,5 year survival rate was 87.2%, 54.1% and 39.5%. Conclusions In the latter 10 years, the amount of blood loss, the operation time, the mortality, and the incidence of pancreatic fistula have decreased significantly compared to the first 10 years.