CAJ | 학술논문

目的探讨横结肠无血管区系膜包裹并缝扎胰腺残端预防胰体尾切除术后胰液漏的临床疗效.方法回顾性分析2011年5月至2014年3月郑州大学附属肿瘤医院收治的69例行胰体尾切除术患者的临床资料.35例患者用丝线间断纵向缝合胰腺残端后采用横结肠无血管区系膜包裹胰腺残端并缝扎作为改良组,34例患者胰腺残端用丝线间断缝合后未做其他处理作为对照组.比较两组患者的胰腺残端处理时间、并发症发生情况、引流管放置时间以及术后住院时间.采用门诊或电话随访,随访时间截至2014年6月.两组均数比较采用t检验,计数资料比较采用x2检验.结果改良组和对照组胰腺残端处理时间分别为(15.2 ±2.1)min和(13.2 ±3.2)min,两组比较,差异无统计学意义(t=1.565,P＞0.05).改良组患者无胰液漏发生,对照组9例患者术后发生胰液漏,两组比较,差异有统计学意义(x2=9.399,P＜0.05).改良组和对照组患者术后胰腺残端引流管放置时间分别为(6.1±2.2)d和(16.6 ±3.5)d,术后住院时间分别为(12.5±2.5)d和(21.5±3.5)d,两组比较,差异有统计学意义(t=-11.902,-9.853,P＜0.05).63例患者获得随访,随访时间为1～35个月,平均随访时间为15个月.随访期间,15例患者死亡,其余恢复良好.结论横结肠无血管区系膜包裹并缝扎胰腺残端能有效预防胰体尾切除术后胰液漏并能缩短术后住院时间.
목적 탐토횡결장무혈관구계막포과병봉찰이선잔단예방이체미절제술후이액루적림상료효.방법 회고성분석2011년5월지2014년3월정주대학부속종류의원수치적69례행이체미절제술환자적림상자료.35례환자용사선간단종향봉합이선잔단후채용횡결장무혈관구계막포과이선잔단병봉찰작위개량조,34례환자이선잔단용사선간단봉합후미주기타처리작위대조조.비교량조환자적이선잔단처리시간、병발증발생정황、인류관방치시간이급술후주원시간.채용문진혹전화수방,수방시간절지2014년6월.량조균수비교채용t검험,계수자료비교채용x2검험.결과 개량조화대조조이선잔단처리시간분별위(15.2 ±2.1)min화(13.2 ±3.2)min,량조비교,차이무통계학의의(t=1.565,P＞0.05).개량조환자무이액루발생,대조조9례환자술후발생이액루,량조비교,차이유통계학의의(x2=9.399,P＜0.05).개량조화대조조환자술후이선잔단인류관방치시간분별위(6.1±2.2)d화(16.6 ±3.5)d,술후주원시간분별위(12.5±2.5)d화(21.5±3.5)d,량조비교,차이유통계학의의(t=-11.902,-9.853,P＜0.05).63례환자획득수방,수방시간위1～35개월,평균수방시간위15개월.수방기간,15례환자사망,기여회복량호.결론 횡결장무혈관구계막포과병봉찰이선잔단능유효예방이체미절제술후이액루병능축단술후주원시간.
Objective To investigate the efficacy of wrapping and suturing of pancreatic stump with the avascular zone of the transverse mesocolon for preventing pancreatic leakage after distal pancreatectomy.Methods The clinical data of 69 patients who received distal pancreatectomy at the Affiliated Tumor Hospital of Zhengzhou University from May 2011 to March 2014 were retrospectively analyzed.The pancreatic stump was wrapped with the avascular zone of the transverse mesocolon after suturing the pancreatic stump in 34 patients (the modified group),and the pancreatic stump of 34 patients was sutured without any other treatment (the control group).The time for pancreatic stump management,complications,time for drainage tube placement and duration of postoperative hospital stay of the 2 groups were compared.Patients were followed-up through outpatient examination and telephone interview till June 2014.The measurement data and the count data were analyzed using the t test and the chi-square test,respectively.Results The time for pancreatic stump management of the modified group and the control group were (15.2 ± 2.1) minutes and (13.2 ± 3.2) minutes,with no significant difference between the 2 groups (t =1.565,P ＞ 0.05).No patient was complicated with other diseases in the modified group,while 9 patients in the control group was complicated with pancreatic fistula,with significant differences between the 2 groups (x2=9.399,P ＜0.05).The time for drainage tube placement of the modified group and the control group were (6.1 ± 2.2) days and (16.6 ± 3.5) days,the duration of postoperative hospital stay were (12.5 ± 2.5) days and (21.5 ± 3.5) days,with significant difference between the 2 groups (t =-11.902,-9.853,P ＜ 0.05).Sixty-three patients were followed up from 1 to 35 months with a mean time of 15 months.Fifteen patients died,and the condition of other patients was normal.Conclusion Wrapping and suturing of the pancreatic stump with the avascular zone of the transverse mesocolon is effective for preventing the pancreatic leakage after distal pancreatectomy and shortens the time of postoperative hospital stay.