改良胰肠黏膜对黏膜间断式吻合在腹腔镜胰十二指肠切除术中的应用
安东均 张成 安琳 王羊 杨林 王金涛 韩立 赵宝国 徐垚
摘 要
目的：探讨腹腔镜胰十二指肠切除术中应用改良胰管-空肠黏膜对黏膜间断式吻合预防和减少胰瘘的临床效果。
方法：回顾性分析2016年3月～2019年6月西安交通大学医学部附属咸阳市中心医院收治的46例行胰十二指肠切除术患者的临床资料，据其应用2种不同胰肠吻合方式分为传统胰套入式吻合（传统组，25例）和改良胰管-空肠黏膜对黏膜间断式吻合组（改良组，21例）。观察比较两组手术时间、胰肠吻合时间、术中出血量、术后胰瘘发生率和其他并发症、术后住院时间等围手术期指标的差异。计数资料和率的比较采用x2x检验；正态分布的计量资料以
±s表示，采用t检验。以 P＜0.05为差异有统计学意义。
结果：2组患者无围手术期死亡，均成功完成预定Whipple手术，全部采用Child消化道重建吻合。2组患者手术完成时间（t=5.382，P＜0.05）差异有统计学意义，其中胰肠吻合时间比较（P＜0.05）改良组少于传统组。术中出血量比较（t=3.321，P＜0.05）；术后胰瘘发生率（x2=3.216，P＜0.05），差异有统计学意义，改良组优于传统组。改良组术后住院时间缩短，（x2=4.026，P＜0.05），差异有统计学意义。
结论：在腹腔镜胰十二指肠切除术患者中，应用改良胰管-空肠黏膜对黏膜间断式吻合，相较于胰肠套入式吻合可以降低术后胰瘘发病率，缩短了手术时间及住院时间，从而改善了临床疗效。
关键词
胰头肿瘤；壶腹部周围肿瘤；胰十二指肠切除术；胰肠吻合；腹腔镜外科
Application of modified pancreaticointestinal mucosa to mucosa intermittent anastomosis in laparoscopic pancreaticoduodenectomy
An Dongjun，Zhang Cheng，An Lin，Wang Yang，Yang Lin，Wang Jintao，Han Li，Zhao Baoguo，Xu Yao（Department of hepatobiliary surgery，the Center Hospital of xianyang City，Xi'an Jiaotong University Health Science Center，Xianyang ，Shanxi 712000，China）
Corresponding author:AN Lin，School of Statistics，Xi'an University of Finance and Economics.Email：3079027819@qq.com
ABSTRACT
Objective：To investigate the clinical effects of laparoscopic pancreaticoduodenectomy on prevention and reduction of pancreatic fistula by modified pancreaticojejunostomy.
Methods:The clinical data of 46 patients receiving pancreaticoduodenectomy in Xianyang central hospital affiliated to the department of medicine of Xi'an jiaotong university from March 2016 to June 2019 were retrospectively analyzed.According to the application of two different pancreaticointestinal anastomosis methods，the patients were divided into the traditional pancreatic duct anastomosis（traditional group，25 cases）and the improved pancreaticoduct-jejunal mucosa to mucosa intermittent anastomosis group（improved group，21 cases）To observe and compare the differences between the two groups in operative time，pancreaticointestinal anastomosis time，intraoperative blood loss，postoperative pancreatic fistula incidence，other complications，postoperative hospital stay and other perioperative indicators.The x2 test was used for the comparison of counting data and rates.The measurement data of normal distribution were expressed as±s and t test was used.P＜0.05 was considered statistically significant.
Results:There was no perioperative death in the two groups，and the scheduled Whipple operation was successfully completed.There was a statistically significant difference in the completion time of surgery between the two groups（t=5.382，P＜0.05）.Comparison of intraoperative blood loss（t=3.321，P＜0.05）；Postoperative incidence of pancreatic fistula（x2=3.216，P＜0.05）was statistically significant，and the improved group was superior to the traditional group.The length of stay after surgery was shortened in the improved group（x2=4.026，P＜0.05），and the difference was statistically significant.
Conclusions:In patients undergoing laparoscopic pancreaticoduodenectomy，the modified pancreaticojejunal mucosa to mucosa intermittent anastomosis，compared with pancreaticojejunostomy，can reduce the incidence of postoperative pancreatic fistula，shorten the operation time and hospital stay，and thus improve the clinical efficacy.
KEY WORDS
Pancreatic head tumor；Tumors around the ampulla；Pancreaticoduodenectomy；pancreatojejunostomy；Laparoscopic surgery
近年来随着腹腔镜技术的进一步熟练、手术经验的积累以及腹腔镜设备与器械的更新，接受腹腔镜胰十二指肠切除术（Laparoscopic pancreaticoduode-nectomy，LPD）的患者呈快速增长趋势［1］。但是胰十二指肠切除术后并发症率，特别是胰瘘仍然困扰着医患双方。西安交通大学医学部附属咸阳市中心医院2016年3月～2019年6月采用不同方式的胰肠吻合行腹腔镜胰十二指肠切除术46例，现就其预防和减少胰瘘的发生取得的效果，报道如下。