中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
Chinese Journal of Digestive Surgery
2015年
11期
916-920
,共5页
胆胰疾病%胰十二指肠切除术%袖套式胰肠吻合
膽胰疾病%胰十二指腸切除術%袖套式胰腸吻閤
담이질병%이십이지장절제술%수투식이장문합
Pancreatic diseases%Pancreaticoduodenectomy%Sleeve pancreaticojejunostomy
目的 探讨袖套式胰肠吻合术在消化道重建中的应用价值.方法 回顾分析2013年7月至2015年2月泸州医学院附属医院收治的40例行袖套式胰肠吻合术患者的临床资料.手术方式行根治性胰十二指肠切除术.采用Kouch手法游离出胰头与十二指肠降部,断面做连续U形的编织样缝合封闭细小胰管,常规进行胰腺断端后壁与空肠壁的缝合,主胰管置入硅胶支撑管固定并保留线头,预留线于空肠壁开口6点及12点方位穿出缝合打结,空肠黏膜如同袖套自然套在主胰管表面,缝合固定胰腺断端前壁,完成胰肠吻合.观察患者术中情况.监测患者术后1、3、5、7d的引流液淀粉酶变化.术后患者每3个月返院复查肝功能、肿瘤标志物、腹部彩色多普勒超声,每6个月复查腹部增强CT,随访时间截至2015年5月.偏态分布的计量资料用M(Qn)表示,采用秩和检验.正态分布的计量资料用-x±s表示.重复测量数据采用重复测量的方差分析.结果 40例患者顺利完成手术,胰肠吻合方式均采用袖套式胰肠吻合.40例患者手术时间为(6.2±1.3)h,其中胰肠吻合时间为(15±6)min,术中出血量为(370±55) mL,肿瘤直径为(2.5±1.5)cm.术后1d引流液淀粉酶为46.300 U(35.575 U,68.600 U),术后3d淀粉酶检测值为34.900U(21.050 U,55.550 U),术后5d淀粉酶检测值为26.750 U(0.000 U,41.400 U),术后7d淀粉酶检测值为0.000 U(0.000 U,30.500U),随着时间的延长,引流液淀粉酶逐渐减少(F=97.268,P＜0.05).40例患者中有2例出现了吻合口引流液淀粉酶升高,但引流液量未达到50 mL/d,而且体温正常,无腹痛及腹膜炎体征,考虑胰液漏可能,经过对症支持治疗后痊愈.其余患者未发现吻合口漏或出血等并发症.40例患者住院时间为(18±5)d.39例患者获得随访,随访时间为3～ 15个月.随访患者中,未发现术后吻合口狭窄、急慢性胰腺炎及胰管结石的发生,其中1例肿瘤复发.结论 应用袖套式胰肠吻合术行胰肠吻合易于掌握,操作安全、可靠,适用于质地柔软的胰腺组织.
目的 探討袖套式胰腸吻閤術在消化道重建中的應用價值.方法 迴顧分析2013年7月至2015年2月瀘州醫學院附屬醫院收治的40例行袖套式胰腸吻閤術患者的臨床資料.手術方式行根治性胰十二指腸切除術.採用Kouch手法遊離齣胰頭與十二指腸降部,斷麵做連續U形的編織樣縫閤封閉細小胰管,常規進行胰腺斷耑後壁與空腸壁的縫閤,主胰管置入硅膠支撐管固定併保留線頭,預留線于空腸壁開口6點及12點方位穿齣縫閤打結,空腸黏膜如同袖套自然套在主胰管錶麵,縫閤固定胰腺斷耑前壁,完成胰腸吻閤.觀察患者術中情況.鑑測患者術後1、3、5、7d的引流液澱粉酶變化.術後患者每3箇月返院複查肝功能、腫瘤標誌物、腹部綵色多普勒超聲,每6箇月複查腹部增彊CT,隨訪時間截至2015年5月.偏態分佈的計量資料用M(Qn)錶示,採用秩和檢驗.正態分佈的計量資料用-x±s錶示.重複測量數據採用重複測量的方差分析.結果 40例患者順利完成手術,胰腸吻閤方式均採用袖套式胰腸吻閤.40例患者手術時間為(6.2±1.3)h,其中胰腸吻閤時間為(15±6)min,術中齣血量為(370±55) mL,腫瘤直徑為(2.5±1.5)cm.術後1d引流液澱粉酶為46.300 U(35.575 U,68.600 U),術後3d澱粉酶檢測值為34.900U(21.050 U,55.550 U),術後5d澱粉酶檢測值為26.750 U(0.000 U,41.400 U),術後7d澱粉酶檢測值為0.000 U(0.000 U,30.500U),隨著時間的延長,引流液澱粉酶逐漸減少(F=97.268,P＜0.05).40例患者中有2例齣現瞭吻閤口引流液澱粉酶升高,但引流液量未達到50 mL/d,而且體溫正常,無腹痛及腹膜炎體徵,攷慮胰液漏可能,經過對癥支持治療後痊愈.其餘患者未髮現吻閤口漏或齣血等併髮癥.40例患者住院時間為(18±5)d.39例患者穫得隨訪,隨訪時間為3～ 15箇月.隨訪患者中,未髮現術後吻閤口狹窄、急慢性胰腺炎及胰管結石的髮生,其中1例腫瘤複髮.結論 應用袖套式胰腸吻閤術行胰腸吻閤易于掌握,操作安全、可靠,適用于質地柔軟的胰腺組織.
목적 탐토수투식이장문합술재소화도중건중적응용개치.방법 회고분석2013년7월지2015년2월로주의학원부속의원수치적40례행수투식이장문합술환자적림상자료.수술방식행근치성이십이지장절제술.채용Kouch수법유리출이두여십이지장강부,단면주련속U형적편직양봉합봉폐세소이관,상규진행이선단단후벽여공장벽적봉합,주이관치입규효지탱관고정병보류선두,예류선우공장벽개구6점급12점방위천출봉합타결,공장점막여동수투자연투재주이관표면,봉합고정이선단단전벽,완성이장문합.관찰환자술중정황.감측환자술후1、3、5、7d적인류액정분매변화.술후환자매3개월반원복사간공능、종류표지물、복부채색다보륵초성,매6개월복사복부증강CT,수방시간절지2015년5월.편태분포적계량자료용M(Qn)표시,채용질화검험.정태분포적계량자료용-x±s표시.중복측량수거채용중복측량적방차분석.결과 40례환자순리완성수술,이장문합방식균채용수투식이장문합.40례환자수술시간위(6.2±1.3)h,기중이장문합시간위(15±6)min,술중출혈량위(370±55) mL,종류직경위(2.5±1.5)cm.술후1d인류액정분매위46.300 U(35.575 U,68.600 U),술후3d정분매검측치위34.900U(21.050 U,55.550 U),술후5d정분매검측치위26.750 U(0.000 U,41.400 U),술후7d정분매검측치위0.000 U(0.000 U,30.500U),수착시간적연장,인류액정분매축점감소(F=97.268,P＜0.05).40례환자중유2례출현료문합구인류액정분매승고,단인류액량미체도50 mL/d,이차체온정상,무복통급복막염체정,고필이액루가능,경과대증지지치료후전유.기여환자미발현문합구루혹출혈등병발증.40례환자주원시간위(18±5)d.39례환자획득수방,수방시간위3～ 15개월.수방환자중,미발현술후문합구협착、급만성이선염급이관결석적발생,기중1례종류복발.결론 응용수투식이장문합술행이장문합역우장악,조작안전、가고,괄용우질지유연적이선조직.
Objective To investigate the application value of sleeve pancreaticojejunostomy in digestive tract reconstruction.Methods The clinical data of 40 patients who underwent sleeve pancreaticojejunostomy at the Affiliated Hospital of Luzhou Medical College between July 2013 and February 2015 were retrospectively analyzed.The head of pancreas and duodenal descending part were drifted out through Kouch technique, sections were sutured in braid-like U shape and the small pancreatic ducts were closed.The posterior wall of pancreatic stump and jejunal wall were sutured routinely and main pancreatic tube was implanted by silica gel with the thrum retained.The reserved lines were gone through at 6 o'clock and 12 o'clock in the jejunal wall to be sutured and knotted, making the jejunal mucosa set on the surface of main pancreatic duct like sleeve, and then the anterior wall pancreatic stump was sutured.The intraoperative situation and amylase concentration of drainage at postoperative day 1, 3, 5, 7 were observed and monitored.The patients were followed up for liver function, tumor markers, abdominal color Doppler ultrasound every 3 months and enhanced abdominal computer tomography every 6 months till May 2015.Measurement data with skewed distribution were presented as M(Qn) and analyzed by rank-sum test.Measurement data with normal distribution data were presented as x ± s.Repeated measurement data were analyzed by the repeated measures ANOVA.Results All the 40 patients underwent sleeve pancreaticojejunostomy successfully.The duration of operation and pancreaticojejunostomy were (6.2 ± 1.3) hours and (15 ±6) minutes, respectively.The volume of intraoperative blood loss was (370 ± 55) mL and diameter of tumor was (2.5 ± 1.5) cm.The amylase concentrations of drainage at postoperative day 1,3, 5, 7 were 46.300 U (35.575 U,68.600 U), 34.900 U (21.050 U, 55.550 U), 26.750 U (0.000 U, 41.400 U) and 0.000 U(0.000 U,30.500 U), showing decrease trend with the time gone (F =97.268, P ＜ 0.05).Among the 40 patients, 2 had increase of drainage amylase concentration at anastomotic stoma with the drain amount less than 50 mL/d, showing normal temperature, no signs of abdominal pain and peritonitis and potential pancreatic leakage, they were recovered after symptomatic and supportive treatments.The other patients had no complications such as anastomotic leakage and hemorrhage.The duration of hospital stay of 40 patients was (18 ±5)days.Thirty-nine patients were followed up for 3-15 months, showing no postoperative anastomotic stenosis, acute or chronic pancreatitis and pancreatolithiasis, 1 of whom with recurrence tumor.Conclusion Sleeve pancreaticojejunostomy is easy to master, safe and reliable, and it is suitable for soft pancreatic tissue.
