目的 探讨“两点法”胰肠吻合方式在胰十二指肠切除术中应用效果。方法 选取2017年11月—2019年3月60例胰十二指肠切除术患者为研究对象并进行回顾性研究,根据手术方式不同将受试者分为对照组和研究组各30例。对照组患者接受捆绑式胰肠吻合方式,观察组患者接受“两点法”胰肠吻合方式,比较两组患者的手术情况及胰瘘发生率。结果 研究组患者术中出血量、胰肠吻合时间及住院时间均显著少于对照组(P<0.05),胰瘘总发生率亦显著低于对照组(P＜0.05)。结论 “两点法”胰肠吻合方式术中出血量少,可有效缩短胰肠吻合时间及住院时间,减少胰瘘发生率,在胰十二指肠切除术中有较高应用价值。
Objective To investigate the effects of pancreaticojejunostomy by two-point method in pancreatico-duodenectomy.Methods From November 2017 to March 2019, 60 patients undergoing pancreaticoduodenectomy were selected and retrospectively studied.According to surgery methods, the patients were divided into control group (n=30) and observation group (n=30).The control group received bundle-invagination pancreaticojejunostomy and the observation group received pancreaticoenterostomy by two-point method.The surgical conditions and the incidence of pancreatic fistula were compared between the two groups.Results The intraoperative blood loss, time of pancreaticoenteric anastomosis, and hospitalization time of the observation group were significantly less than those of the control group (P<0.05).The total incidence rate of pancreatic fistula of the observation group was significantly lower than that of the control group (P<0.05).Conclusion Pancreaticoenterostomy by two-point method can effectively shorten the time of pancreaticoenteric anastomosis and hospitalization, reduce the incidence of pancreatic fistula with less bleeding, thus has high application value in pancreaticoduodenectomy.
[1] 孟钰.不同胰肠吻合方式在胰十二指肠切除术中的临床效果观察[J].临床研究, 2016,24(2):37-38.
[2] 张军杰,姚坤厚,华龙,等.不同胰肠吻合方式在胰十二指肠切除术中的疗效研究[J].中国现代药物应用, 2016,10(7):35-36.
[3] 郑肇明,袁阳春,林嘉瑜,等.不同胰肠吻合方式在胰十二指肠切除术中临床效果的比较[J].中国基层医药, 2016,23(11):1683-1686.
[4] 周辉年,俞泽元,杨含腾,等.两种胰肠吻合术在胰十二指肠切除术中应用的对比研究[J].中国普通外科杂志, 2018,27(9):25-31.
[5] 黄佳飞,张倜,周洪渊,等.胰肠吻合方式对胰十二指肠切除术后胰瘘的影响[J].中国肿瘤临床, 2015,42(8):441-445.
[6] Mcmillan M T, Christein J D, Callery M P, et al.Comparing the burden of pancreatic fistulas after pancreatoduodenectomy and distal pancreatectomy[J].Surgery, 2016,159(4):1013-1022.
[7] Pedrazzoli S.Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF): a systematic review and analysis of the POPF-related mortality rate in 60,739 patients retrieved from the English literature published between 1990 and 2015[J].Medicine, 2017,96(19):e6858.
[8] Tol J A, Busch O R, van Delden O M, et al.Shifting role of operative and nonoperative interventions in managing complications after pancreatoduodenectomy: what is the preferred intervention?[J].Surgery, 2014,156(3):622-631.
[9] Cloyd J M, Crane C H, Koay E J, et al.Impact of hypofractionated and standard fractionated chemoradiation prior to pancreatoduodenectomy for pancreatic ductal adenocarcinoma[J].Cancer, 2016,122(17):2671-2679.
[10] Gerhards M F.Antecolic versus retrocolic route of the gastroenteric anastomosis after pancreatoduodenectomy: a randomized controlled trial[J].Ann Surg, 2014,259(1):45-51.
[11] Shrikhande S V, Sivasanker M, Vollmer C M, et al.Pancreatic anastomosis after pancreatoduodenectomy: a position statement by the International Study Group of Pancreatic Surgery (ISGPS)[J].Surgery, 2017,161(5):1221.
[12] Eshuis W J, Tol J A M G, Nio C Y, et al.Leakage of the gastroenteric anastomosis after pancreatoduodenectomy[J].Surgery, 2014,156(1):75-82.
[13] Eshuis W J, De Bree K, Sprangers M A, et al.Gastric emptying and quality of life after pancreatoduodenectomy with retrocolic or antecolic gastroenteric anastomosis[J].Br J Surg, 2015,102(9):1123-1132.
