中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2014年
11期
867-870
,共4页
胰十二指肠切除术%胰肠吻合术%贯穿缝合式胰肠吻合术%胰瘘
胰十二指腸切除術%胰腸吻閤術%貫穿縫閤式胰腸吻閤術%胰瘺
이십이지장절제술%이장문합술%관천봉합식이장문합술%이루
Pancreaticoduodenectomy%Pancreaticojejunostomy%Penetrating-suture type pancreaticojejunostomy%Pancreatic fistula
目的 探讨贯穿缝合式胰肠吻合(PPJ)在胰十二指肠切除术中的临床应用价值.方法 回顾性分析2002年6月至2012年3月江苏省泰兴市人民医院收治的77例行根治性胰十二指肠切除术患者的临床资料.34例采用PPJ者为研究组;43例根据胰腺的质地、大小,胰管的粗细选择不同的胰肠吻合方法者(胰管直径≥4 mm,选用胰管黏膜吻合;胰腺切断≤3 mm选用胰肠端端套入式或捆绑式胰肠吻合)为对照组.术后胰瘘的诊断参照国际胰瘘研究小组(ISGPF)的诊断与分级标准进行诊断,有临床意义的胰瘘为B级和C级胰瘘.采用门诊和电话随访,随访时间截至2012年5月.计量资料符合正态分布数据用x±s表示,采用t检验;不符合正态分布用M(范围)表示,统计采用Wilcoxon秩和检验.计数资料用x2检验或Fisher确切概率法.结果 研究组患者均在术中找到胰管,研究组和对照组胰管平均直径均为3 mm.研究组无胰管外引流,对照组为4例,两组比较,差异有统计学意义(x2=3.632,P＜0.05);研究组胰肠吻合时间为12 min(8 ～25 min),对照组记录不详.研究组和对照组的手术时间均为(304±60) min,术中出血量分别为(475 ±75)mL和(500 ±97) mL,术中输血例数分别为24例(70.6％)和29例(67.4％),术中中位输血量分别为400 mL(300 ～800 mL)和600 mL(300～1 200 mL),术后中位住院时间分别为18d(11～32 d)和20 d(9 ～44 d),两组患者手术治疗情况比较,差异无统计学意义(t=1.293,0.619,x2=0.088,Z=0.165,0.074,P＞0.05).研究组和对照组患者B、C级胰瘘(均为胰肠吻合口瘘)发生率分别为0和27.9％(12/43),胰瘘相关病死率分别为0和11.6％(5/43),两组比较,差异有统计学意义(x2=11.232,4.237,P＜0.05).研究组和对照组患者术后胆汁漏、腹腔出血、胃排空延迟障碍的发生率分别为5.9％(2/34)、2.9％(1/34)、5.9％(2/34)和11.6％ (5/43)、7.0％(3/43)、14.0％(6/43),两组比较,差异无统计学意义(P＞0.05).两组共56例患者获得门诊随访,随访时间为术后9个月至5年.研究组26例患者经影像学检查未见胰管明显扩张.对照组30例患者出现不同程度的胰管扩张.结论 PPJ简单、可靠,在胰十二指肠切除术中应用疗效较好.
目的 探討貫穿縫閤式胰腸吻閤(PPJ)在胰十二指腸切除術中的臨床應用價值.方法 迴顧性分析2002年6月至2012年3月江囌省泰興市人民醫院收治的77例行根治性胰十二指腸切除術患者的臨床資料.34例採用PPJ者為研究組;43例根據胰腺的質地、大小,胰管的粗細選擇不同的胰腸吻閤方法者(胰管直徑≥4 mm,選用胰管黏膜吻閤;胰腺切斷≤3 mm選用胰腸耑耑套入式或捆綁式胰腸吻閤)為對照組.術後胰瘺的診斷參照國際胰瘺研究小組(ISGPF)的診斷與分級標準進行診斷,有臨床意義的胰瘺為B級和C級胰瘺.採用門診和電話隨訪,隨訪時間截至2012年5月.計量資料符閤正態分佈數據用x±s錶示,採用t檢驗;不符閤正態分佈用M(範圍)錶示,統計採用Wilcoxon秩和檢驗.計數資料用x2檢驗或Fisher確切概率法.結果 研究組患者均在術中找到胰管,研究組和對照組胰管平均直徑均為3 mm.研究組無胰管外引流,對照組為4例,兩組比較,差異有統計學意義(x2=3.632,P＜0.05);研究組胰腸吻閤時間為12 min(8 ～25 min),對照組記錄不詳.研究組和對照組的手術時間均為(304±60) min,術中齣血量分彆為(475 ±75)mL和(500 ±97) mL,術中輸血例數分彆為24例(70.6％)和29例(67.4％),術中中位輸血量分彆為400 mL(300 ～800 mL)和600 mL(300～1 200 mL),術後中位住院時間分彆為18d(11～32 d)和20 d(9 ～44 d),兩組患者手術治療情況比較,差異無統計學意義(t=1.293,0.619,x2=0.088,Z=0.165,0.074,P＞0.05).研究組和對照組患者B、C級胰瘺(均為胰腸吻閤口瘺)髮生率分彆為0和27.9％(12/43),胰瘺相關病死率分彆為0和11.6％(5/43),兩組比較,差異有統計學意義(x2=11.232,4.237,P＜0.05).研究組和對照組患者術後膽汁漏、腹腔齣血、胃排空延遲障礙的髮生率分彆為5.9％(2/34)、2.9％(1/34)、5.9％(2/34)和11.6％ (5/43)、7.0％(3/43)、14.0％(6/43),兩組比較,差異無統計學意義(P＞0.05).兩組共56例患者穫得門診隨訪,隨訪時間為術後9箇月至5年.研究組26例患者經影像學檢查未見胰管明顯擴張.對照組30例患者齣現不同程度的胰管擴張.結論 PPJ簡單、可靠,在胰十二指腸切除術中應用療效較好.
목적 탐토관천봉합식이장문합(PPJ)재이십이지장절제술중적림상응용개치.방법 회고성분석2002년6월지2012년3월강소성태흥시인민의원수치적77례행근치성이십이지장절제술환자적림상자료.34례채용PPJ자위연구조;43례근거이선적질지、대소,이관적조세선택불동적이장문합방법자(이관직경≥4 mm,선용이관점막문합;이선절단≤3 mm선용이장단단투입식혹곤방식이장문합)위대조조.술후이루적진단삼조국제이루연구소조(ISGPF)적진단여분급표준진행진단,유림상의의적이루위B급화C급이루.채용문진화전화수방,수방시간절지2012년5월.계량자료부합정태분포수거용x±s표시,채용t검험;불부합정태분포용M(범위)표시,통계채용Wilcoxon질화검험.계수자료용x2검험혹Fisher학절개솔법.결과 연구조환자균재술중조도이관,연구조화대조조이관평균직경균위3 mm.연구조무이관외인류,대조조위4례,량조비교,차이유통계학의의(x2=3.632,P＜0.05);연구조이장문합시간위12 min(8 ～25 min),대조조기록불상.연구조화대조조적수술시간균위(304±60) min,술중출혈량분별위(475 ±75)mL화(500 ±97) mL,술중수혈례수분별위24례(70.6％)화29례(67.4％),술중중위수혈량분별위400 mL(300 ～800 mL)화600 mL(300～1 200 mL),술후중위주원시간분별위18d(11～32 d)화20 d(9 ～44 d),량조환자수술치료정황비교,차이무통계학의의(t=1.293,0.619,x2=0.088,Z=0.165,0.074,P＞0.05).연구조화대조조환자B、C급이루(균위이장문합구루)발생솔분별위0화27.9％(12/43),이루상관병사솔분별위0화11.6％(5/43),량조비교,차이유통계학의의(x2=11.232,4.237,P＜0.05).연구조화대조조환자술후담즙루、복강출혈、위배공연지장애적발생솔분별위5.9％(2/34)、2.9％(1/34)、5.9％(2/34)화11.6％ (5/43)、7.0％(3/43)、14.0％(6/43),량조비교,차이무통계학의의(P＞0.05).량조공56례환자획득문진수방,수방시간위술후9개월지5년.연구조26례환자경영상학검사미견이관명현확장.대조조30례환자출현불동정도적이관확장.결론 PPJ간단、가고,재이십이지장절제술중응용료효교호.
Objective To investigate the clinical value of penetrating-suture type pancreaticojejunostomy (PPJ) after pancreaticoduodenectomy (PD).Methods The clinical data of 77 patients who received pancreaticoduodenectomy from Taixing People's Hospital from June 2002 to March 2012 were retrospectively analyzed.Of all the patients,34 received PPJ after PD (PPJ group),and the other 43 patients received PJ anastomosis (control group) based on the texture and size of the pancreas,pancreatic duct diameter (duct-to-mucosa pancreaticojejunostomy for pancreatic duct diameter ≥ 4 mm,end-to-end or binding pancreaticojejunostomy for pancreatic duct diameter ≤3 mm).Pancreatic fistula was diagnosed according to the criteria of the International Study Group on Pancreatic Fistula,including grade B or C pancreatic fistula with clinical value.Patients were followed-up through outpatient examination and telephone interview till May 2012.Data were presented by x ± s or median (range) and the t-test and Wilcoxon rank-sum test were used to evaluate quantitative data with or without normal distribution,respectively.Qualitative data were analyzed using Pearson x2 test or Fisher's exact test.Results The mean diameter of the pancreatic duct was 3 mm for both the PPJ group and the control group.The external drainage via the pancreatic duct stent was not used in the PPJ group,compared with 4 cases in the control group,showing a statistically significant difference between the 2 groups (x2=3.632,P ＜ 0.05).The duration of pancreaticojejunostomy was 12 minutes (range,8-25 minutes) in the PPJ group,while no records in the control group.The operation time and intraoperative blood loss in the PPJ group and the control group were (304 ± 60)minutes and (475 ± 75) mL,(304 ± 60) minutes and (500 ± 97) mL,respectively.Twenty-four (70.6％) patients in the PPJ group and 29 (67.4％) patients in the control group received intraoperative blood transfusion,with volume of 400 mL (range,300-800 mL) and 600 mL (range,300-1 200 mL),respectively.The median duration of postoperative hospital stay were 18 days (range,11-32 days) in the PPJ group and 20 days (range,9-44 days) in the control group.None of these comparisons were statistically significant between the 2 groups (t =1.293,0.619,x2=0.088,Z =0.165,0.074,P ＞0.05).The rate of grade B or C pancreatic fistula were 0 for the PPJ group and 27.9％ (12/43) for the control group,and the mortality rate of patients who had pancreatic fistula were 0 and 11.6％ (5/43) for the PPJ group and the control group,with statistical significance (x2=11.232,4.237,P ＜0.05).The overall incidence of bile leakage,peritoneal bleeding and delayed gastric emptying in the PPJ group and the control group were 5.9％ (2/34),2.9％ (1/34),5.9％ (2/34) and 11.6％ (5/43),7.0％ (3/43),14.0％ (6/43),with no significance difference (P ＞0.05).Fifty-six patients were followed up after operation from 9 months to 5 years.Pancreatic duct dilation was detected by imaging examination for 26 patients in the control group.Conclusions PPJ is a simple and feasible approach with better clinical efficacy after PD.
