CAJ | 학술논문

目的介绍改良胰肠、胰胃吻合及胆胰分别引流方法在胰十二指肠切除术中的应用.方法 2012年1月至2014年1月,华中科技大学同济医学院附属同济医院开展的171例胰十二指肠切除术依据术前CT和术中探查判断胰腺质地,对硬质胰腺和软质胰腺分别采用改良胰肠和胰胃吻合,并采取胆汁胰液分流的消化道重建方式.收集术前、术中和术后资料分析其临床应用效果.结果 171例均采用胆汁胰液分流的消化道重建方式,其中92例为胰胃吻合,79例为胰肠吻合.手术(含胰胃或胰肠吻合时间)中位时间为240.0 min(186.0 ～ 414.0 min),手术死亡率为0;术后并发症发生率为18.1％ (n=31),包括术后出血4例,胆漏3例,肺部感染2例,切口脂肪液化并感染8例,胃瘫6例,腹腔感染4例,胰瘘4例(2例A级和2例B级胰瘘).结论依据胰腺质地分别采用胰肠和胰胃吻合,并采用胆胰分流的消化道重建方式对降低胰十二指肠切除术后严重并发症发生具有积极意义.
목적 개소개량이장、이위문합급담이분별인류방법재이십이지장절제술중적응용.방법 2012년1월지2014년1월,화중과기대학동제의학원부속동제의원개전적171례이십이지장절제술의거술전CT화술중탐사판단이선질지,대경질이선화연질이선분별채용개량이장화이위문합,병채취담즙이액분류적소화도중건방식.수집술전、술중화술후자료분석기림상응용효과.결과 171례균채용담즙이액분류적소화도중건방식,기중92례위이위문합,79례위이장문합.수술(함이위혹이장문합시간)중위시간위240.0 min(186.0 ～ 414.0 min),수술사망솔위0;술후병발증발생솔위18.1％ (n=31),포괄술후출혈4례,담루3례,폐부감염2례,절구지방액화병감염8례,위탄6례,복강감염4례,이루4례(2례A급화2례B급이루).결론 의거이선질지분별채용이장화이위문합,병채용담이분류적소화도중건방식대강저이십이지장절제술후엄중병발증발생구유적겁의의.
Objective To evaluate a modified technique for digestive tract reconstruction after pancreaticoduodenectomy(PD).Methods 171 admitted patients were enrolled from January 2012 to January 2014 at our department.According to the preoperative CT scan and intraoperative exploration,pancreaticogastrostomy was performed in cases of soft pancreas texture,while pancreaticojejunostomy was performed in fibrotic pancreas after PD.Bypassed biliary-pancreatic reconstruction were applied on all cases.Results For the digestive tract reconstruction after PD,92 patients underwent pancreaticogastrostomy,79 patients underwent pancreaticojejunostomy.The median time for the surgery was 240.0 minutes (ranging from 186 to 414 min).Operative mortality was zero,and morbidity was 18.1％ (n =31),including hemorrhage (n =4),biliary fistula (n =3),pulmonary infection (n =2),adipose liquefaction and operative incision infection (n =0),delayed gastric emptying (DGE) (n =6),abdominal abscess (n =4).Fout patients developed a pancreatic fistula (type A in 2,type B in 2).Conclusions Modified pancreaticogastrostomy,pancreaticojejunostomy and biliary-pancreatic bypass is safe for digestive tract reconstruction after pancreaticoduodenectomy.