CAJ | 학술논문

目的探讨Blumgart吻合对胰十二指肠切除术后胰瘘发生的影响及其安全性、有效性.方法回顾性分析205例施行胰十二指肠切除术患者的临床资料.将患者按照不同的吻合方式分为三组:Blumgart吻合组(A组)37例,胰管空肠黏膜端侧吻合组(B组)39例,传统的套入式吻合组(C组)129例;比较三种不同胰肠吻合方法对胰瘘及其他并发症发生率的影响.结果三组患者的术后胰瘘发生率差异有统计学意义.A、B、C组的术后胰瘘发生率分别是8.1％、23.1％和30.2％.多因素分析显示:胰腺质地较软、胰管直径＜3 mm、非Blumgart吻合是术后胰瘘的独立性危险因素.亚组分析显示,Blumgart吻合在胰管直径＜3mm组的患者中,术后胰瘘的发生率低于胰管空肠黏膜吻合术(P=0.038)与传统的套入式吻合术(P=0.011);Blumgart吻合在胰腺质地较软的患者组中,术后胰瘘的发生率低于传统的套入式吻合术(P=0.001).结论 Blumgart吻合可以显著减少术后胰瘘的发生率,可在临床上广泛应用.
목적 탐토Blumgart문합대이십이지장절제술후이루발생적영향급기안전성、유효성.방법 회고성분석205례시행이십이지장절제술환자적림상자료.장환자안조불동적문합방식분위삼조:Blumgart문합조(A조)37례,이관공장점막단측문합조(B조)39례,전통적투입식문합조(C조)129례;비교삼충불동이장문합방법대이루급기타병발증발생솔적영향.결과 삼조환자적술후이루발생솔차이유통계학의의.A、B、C조적술후이루발생솔분별시8.1％、23.1％화30.2％.다인소분석현시:이선질지교연、이관직경＜3 mm、비Blumgart문합시술후이루적독립성위험인소.아조분석현시,Blumgart문합재이관직경＜3mm조적환자중,술후이루적발생솔저우이관공장점막문합술(P=0.038)여전통적투입식문합술(P=0.011);Blumgart문합재이선질지교연적환자조중,술후이루적발생솔저우전통적투입식문합술(P=0.001).결론 Blumgart문합가이현저감소술후이루적발생솔,가재림상상엄범응용.
Objective To evaluate the impact of the Blumgart anastomosis in pancreaticojejunostomy on the incidence of postoperative pancreatic fistula (POPF) after pancreaticoduodeneetomy (PD),and to study its safety and efficacy.Methods A total of 205 patients who underwent PD between January 2011 and February 2013 were retrospectively studied.The patients were divided into three groups depending on the pancreaticoenteric reconstruction:the Blumgart anastomosis group (n=37),the duct-to-mucosa anastomosis group (n =39) and the traditional invagination group (n=129).Postoperative morbidity were analyzed.Results The incidences of POPF after the Blumgart anastomosis (8.1％) was significantly lower than the duct-to-mucosa anastomosis group (23.1％ ; P=0.037) and the traditional invagination anastomosis group (30.2％ ; P=0.012).Multivariate analysis revealed soft pancreatic texture,pancreatic duct diameter ＜3 mm and non-Blumgart anastomosis were independent risk factors of POPF.On subgroup analysis,the Blumgart anastomosis was superior to the duct-to-mucosa anastomosis in patients with pancreatic duct diameter ＜ 3 mm (P=0.038),and showed advantages over the traditional invagination anastomosis in patients with soft pancreatic texture (P =0.001),as well as in patients with pancreatic duct diameter ＜ 3 mm (P=0.011).Conclusions The Blumgart anastomosis is a safe technique,and it could significantly reduced the rate of POPF.It should be routinely used for pancreatoenteric reconstruction after PD.