国际外科学杂志
國際外科學雜誌
국제외과학잡지
INTERNATIONAL JOURNAL OF SURGERY
2013年
9期
592-595,封3
,共5页
胰十二指肠切除术%胰肠吻合%胰瘘%手术后并发症%出血
胰十二指腸切除術%胰腸吻閤%胰瘺%手術後併髮癥%齣血
이십이지장절제술%이장문합%이루%수술후병발증%출혈
Pancreaticoduodenectomy%Pancreatico-jejunal invaginated anastomosis%Pancreatic fistula%Postoperative complications%Hemorrhage
目的 对胰十二指肠切除术采用保留空肠黏膜与去空肠黏膜胰肠直接套入加捆扎两种不同的吻合方式进行探讨.方法 2003年2月 2012年12月对58例胰十二指肠切除术患者采用胰空肠套入吻合术；其中A组28例采用保留空肠黏膜残胰直接套入空肠3～4 cm,在距离残胰腺断端2～3 cm处将包盖于残胰腺体的空肠段用7-0丝线予以捆扎.B组30例则为去黏膜化,空肠黏膜外翻3 cm并去黏膜化处理并行肠黏膜下肌层与残胰体断端缝合,之后将空肠复位,随后按A组方法将包盖于残胰体的空肠予以捆扎.结果 A、B两组胰-肠吻合时间比较,A组比B组平均缩短(36±0.34) min(P ＜0.001)；A组和B两组术后并发胰瘘分别为0和20.0％；A组和B两组术后迟发性残胰断端出血分别为3.6％和3.3％.结论 在胰十二指肠切除术采用保留空肠黏膜与去空肠黏膜两种不同胰肠吻合方式中,前者不受残胰质地、胰管大小影响和具有操作简便以及可以降低胰瘘发病率的优点.
目的 對胰十二指腸切除術採用保留空腸黏膜與去空腸黏膜胰腸直接套入加捆扎兩種不同的吻閤方式進行探討.方法 2003年2月 2012年12月對58例胰十二指腸切除術患者採用胰空腸套入吻閤術；其中A組28例採用保留空腸黏膜殘胰直接套入空腸3～4 cm,在距離殘胰腺斷耑2～3 cm處將包蓋于殘胰腺體的空腸段用7-0絲線予以捆扎.B組30例則為去黏膜化,空腸黏膜外翻3 cm併去黏膜化處理併行腸黏膜下肌層與殘胰體斷耑縫閤,之後將空腸複位,隨後按A組方法將包蓋于殘胰體的空腸予以捆扎.結果 A、B兩組胰-腸吻閤時間比較,A組比B組平均縮短(36±0.34) min(P ＜0.001)；A組和B兩組術後併髮胰瘺分彆為0和20.0％；A組和B兩組術後遲髮性殘胰斷耑齣血分彆為3.6％和3.3％.結論 在胰十二指腸切除術採用保留空腸黏膜與去空腸黏膜兩種不同胰腸吻閤方式中,前者不受殘胰質地、胰管大小影響和具有操作簡便以及可以降低胰瘺髮病率的優點.
목적 대이십이지장절제술채용보류공장점막여거공장점막이장직접투입가곤찰량충불동적문합방식진행탐토.방법 2003년2월 2012년12월대58례이십이지장절제술환자채용이공장투입문합술；기중A조28례채용보류공장점막잔이직접투입공장3～4 cm,재거리잔이선단단2～3 cm처장포개우잔이선체적공장단용7-0사선여이곤찰.B조30례칙위거점막화,공장점막외번3 cm병거점막화처리병행장점막하기층여잔이체단단봉합,지후장공장복위,수후안A조방법장포개우잔이체적공장여이곤찰.결과 A、B량조이-장문합시간비교,A조비B조평균축단(36±0.34) min(P ＜0.001)；A조화B량조술후병발이루분별위0화20.0％；A조화B량조술후지발성잔이단단출혈분별위3.6％화3.3％.결론 재이십이지장절제술채용보류공장점막여거공장점막량충불동이장문합방식중,전자불수잔이질지、이관대소영향화구유조작간편이급가이강저이루발병솔적우점.
Objective To evaluated the preserving or removing jejunal mucosa pancreatico-jejunal invaginated anastomosis in pancreaticoduodenectomy.Methods Between February 2003 and December 2012,58 patients underwent pancreaticoduodenectomy using pancreaticojejunal invaginated anastomosis in our department.In group A,28 patients received pancreatico-jejunal invaginated anastomosis using jejunum preserving technique.Briefly,3 to 4 cm remanent pancreas was inserted into jejunum and thc jcjunum was bundled up using No.7 silk thread at 2 to 3 cm distant to the cutting surface of the pancreas.In group B,30 patients received pancreatico-jejunal invaginated anastomosis using jejunum removing technique.Briefly,the jejunum mucosa was everted and the proximal 3 cmlong mucosa was removed.Then the everted jejunum was re-positioned and the ending of the jejunum was interruptedly sutured to the remanent pancreas.Finally,the covered jejunum was tied up as the group A.Results The pancrcatico-jejunal anastomosis time was 36 ±0.34 minutes shorter in group A than group B (P ＜0.001).The incidence of pancreatic fistula was higher in group B (20.0％) than group A (0％).In contrast,the incidence of post-operative pancreatic bleeding was compared between the two groups (3.6％ vs 3.3％,P =1.000).Conclusions Preserving ejunum mucosa pancreatico-jejunal invaginated anastomosis was unaffected by pancreatic texture pancreatic duct size and position.This method takes the advantages of simple operation and reducing the incidence of pancreatic fistula.
