CAJ | 학술논문

目的分析胰十二指肠切除术后胰管空肠黏膜对黏膜吻合和套入式胰肠端端吻合术后并发症发生情况,为选择最佳的胰肠重建方式提供依据.方法回顾性分析2004年6月至2008年5月于四川大学华西医院接受胰十二指肠切除术的342例患者的临床资料.根据吻合方式的不同将患者分为黏膜-黏膜吻合组(179例),采用胰管空肠黏膜对黏膜吻合；套入式吻合组(163例),采用套入式胰肠端端吻合.根据Clavien术后并发症诊断和分级标准分析胰管空肠黏膜对黏膜吻合和套入式胰肠端端吻合与术后并发症发生率及其严重程度的关系.计量资料采用t检验,计数资料采用x2检验.结果本组患者术后总体并发症发生率为48.8％(167/342),其中黏膜-黏膜组术后并发症发生率为38.0％(68/179),套入式吻合组为60.7％(99/163),两组比较,差异有统计学意义(x2=17.667,P＜0.05).在术后并发症的严重程度分级中,黏膜-黏膜组患者Ⅱ级和Ⅴ级并发症发生率分别为16.8％(30/179)和1.1％(2/179),显著低于套入式吻合组的28.2％(46/163)和5.5％(9/163),两组比较,差异有统计学意义(x2=6.484,5.316,P＜0.05).结论胰十二指肠切除术采用胰管空肠黏膜对黏膜吻合的术后并发症发生率显著低于套入式胰肠端端吻合,胰管空肠黏膜对黏膜吻合可能更有利于患者术后的恢复.
목적 분석이십이지장절제술후이관공장점막대점막문합화투입식이장단단문합술후병발증발생정황,위선택최가적이장중건방식제공의거.방법 회고성분석2004년6월지2008년5월우사천대학화서의원접수이십이지장절제술적342례환자적림상자료.근거문합방식적불동장환자분위점막-점막문합조(179례),채용이관공장점막대점막문합；투입식문합조(163례),채용투입식이장단단문합.근거Clavien술후병발증진단화분급표준분석이관공장점막대점막문합화투입식이장단단문합여술후병발증발생솔급기엄중정도적관계.계량자료채용t검험,계수자료채용x2검험.결과 본조환자술후총체병발증발생솔위48.8％(167/342),기중점막-점막조술후병발증발생솔위38.0％(68/179),투입식문합조위60.7％(99/163),량조비교,차이유통계학의의(x2=17.667,P＜0.05).재술후병발증적엄중정도분급중,점막-점막조환자Ⅱ급화Ⅴ급병발증발생솔분별위16.8％(30/179)화1.1％(2/179),현저저우투입식문합조적28.2％(46/163)화5.5％(9/163),량조비교,차이유통계학의의(x2=6.484,5.316,P＜0.05).결론 이십이지장절제술채용이관공장점막대점막문합적술후병발증발생솔현저저우투입식이장단단문합,이관공장점막대점막문합가능경유리우환자술후적회복.
Objective To analyze postoperative complications of duct-to-mucosa pancreaticojejunostomy and side-to-end or end-to-end pancreaticojejunostomy following pancreaticoduodenectomy.Methods The clinical data of 342 patients who underwent pancreaticoduodenectomy at the West China Hospital of Sichuan University from June 2004 to May 2008 were retrospectively analyzed.All patients were divided into the duct-to-mucosa group (179 cases)and side-to-end or end-to-end group(163 cases)according to the styles of pancreaticojejunostomy.The relationship between the incidence and severity of postoperative complications of the 2 anastomotic styles were analyzed according to the Clavien grading system.The measurement data and the count data were analyzed using the t test or chi-square test.Results The overall complication rate was 48.8％(167/342),and the complication rate was 38.0％(68/179)in the side-to-end group and 60.7％(99/163)in the side-to-end or end-to-end group,with a significant difference between the 2 groups(x2=17.667,P ＜0.05).The incidences of grade Ⅱ and grade Ⅴ complications were 16.8％(30/179)and 1.1％(2/179)in the duct-to-mucosa group,which were significantly lower than 28.2％(46/163)and 5.5％(9/163)of the side-to-end or end-to-end group(x2=6.484,5.316,P ＜0.05).Conclusion Compared with side-to-end or end-to-end pancreaticojejunostomy,duct-to-mucosa pancreaticojejunostomy is a better style with a lower incidence of postoperative complication.