CAJ | 학술논문

目的评价不同胰肠吻合方式在胰十二指肠切除术中的临床疗效,为胰肠吻合方式的选择决策提供依据.方法回顾性分析上海交通大学医学院附属仁济医院2010年1月至2013年1月间305例因恶性疾病行胰十二指肠切除术患者的临床资料.对于胰管直径≥3 mm的患者采用胰管空肠黏膜吻合(120例);对于胰管直径＜3 mm者,进一步比较胰腺残端与空肠管口径,若胰腺残端较粗大且大于空肠管径者采用改良Child法胰肠吻合(80例),若胰腺残端直径小于空肠管径者选择捆绑式胰肠吻合(105例).统计比较不同胰肠吻合方式术后并发症的发生率,评价临床疗效.计量资料采用t检验,计数资料采用x2检验.结果改良Child法胰肠吻合组胰腺残端直径明显大于捆绑式胰肠吻合组(F=5.78,P＜0.05).本组总体胰瘘发生率为11.1％(34/305).三组患者术后胰瘘、腹腔出血、腹腔感染、消化功能异常、平均住院时间及术后死亡,差异无统计学意义(x2 =1.51,2.78,1.16,3.75,1.94,F=2.13,P＞0.05).结论在行胰十二指肠切除术时,可以根据胰管直径、胰腺残端直径及空肠管口径合理选择不同的胰肠吻合方式.
목적 평개불동이장문합방식재이십이지장절제술중적림상료효,위이장문합방식적선택결책제공의거.방법 회고성분석상해교통대학의학원부속인제의원2010년1월지2013년1월간305례인악성질병행이십이지장절제술환자적림상자료.대우이관직경≥3 mm적환자채용이관공장점막문합(120례);대우이관직경＜3 mm자,진일보비교이선잔단여공장관구경,약이선잔단교조대차대우공장관경자채용개량Child법이장문합(80례),약이선잔단직경소우공장관경자선택곤방식이장문합(105례).통계비교불동이장문합방식술후병발증적발생솔,평개림상료효.계량자료채용t검험,계수자료채용x2검험.결과 개량Child법이장문합조이선잔단직경명현대우곤방식이장문합조(F=5.78,P＜0.05).본조총체이루발생솔위11.1％(34/305).삼조환자술후이루、복강출혈、복강감염、소화공능이상、평균주원시간급술후사망,차이무통계학의의(x2 =1.51,2.78,1.16,3.75,1.94,F=2.13,P＞0.05).결론 재행이십이지장절제술시,가이근거이관직경、이선잔단직경급공장관구경합리선택불동적이장문합방식.
Objective To evaluate the pancreaticojejunostomy procedures selection strategy after pancreaticoduodenectomy.Methods The clinical data of 305 cases who received pancreaticoduodenetomy at Shanghai Renji Hospital from Jan 2010 to Jan 2013 were retrospectively analyzed.For patients with pancreatic duct diameter≥3 mm,duct-to-mucosa pancreaticojejunostomy was applied(120 cases).For duct diameter ＜ 3 mm,modified Child pancreaticojejunostomy was applied to 80 cases when pancreatic stump was large,or binding pancreaticojejunostomy procedures was applied to 105 cases while pancreatic stump was small.Results The diameter of the pancreatic stump in modified Child group was significantly larger than that in the binding group (F =5.78,P ＜ 0.05).The overall incidence of pancreatic fistula was 11.1％ (34/305).There were no significant differences in the incidences of pancreatic fistula,peritoneal bleeding,abdominal infection,digestive dysfunction rate,the mean duration of hospital and the death cases among the three groups (x2 =1.51,2.78,1.16,3.75,1.94,F=2.13,P＞0.05).Conclusions Three different pancreaticojejunostomies based on the size of pancreatic duct and pancreatic stump are equally safe and effective as a reconstructive method after pancreaticoduodenectomy.