切换至 "中华医学电子期刊资源库"
高级检索
中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2022, Vol. 11 ›› Issue (05) : 458 -462. doi: 10.3877/cma.j.issn.2095-3232.2022.05.007

临床研究

改良内陷式胰肠吻合在胰十二指肠切除术中的应用
李利平1, 游意莹1, 沈宁1, 曹宏2, 王艳玲1,†()   
  1. 1. 510630　广州，中山大学附属第三医院麻醉科
    2. 130033　长春，吉林大学中日联谊医院（新民院区）普通外科
  • 收稿日期:2022-05-05 出版日期:2022-10-10
  • 通信作者: 王艳玲
  • 基金资助:
    广东省自然科学基金(2020A1515010153)

Application of modified invagination pancreaticojejunostomy in pancreaticoduodenectomy

Liping Li1, Yiying You1, Ning Shen1, Hong Cao2, Yanling Wang1,†()   

  1. 1. Department of Anesthesiology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
    2. Department of General Surgery, China-Japan Union Hospital of Jilin University (Xinmin Hospital), Changchun 130033, China
  • Received:2022-05-05 Published:2022-10-10
  • Corresponding author: Yanling Wang
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

李利平, 游意莹, 沈宁, 曹宏, 王艳玲. 改良内陷式胰肠吻合在胰十二指肠切除术中的应用[J]. 中华肝脏外科手术学电子杂志, 2022, 11(05): 458-462.

Liping Li, Yiying You, Ning Shen, Hong Cao, Yanling Wang. Application of modified invagination pancreaticojejunostomy in pancreaticoduodenectomy[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2022, 11(05): 458-462.

目的

探讨改良内陷式胰肠吻合在胰十二指肠切除术（PD）中应用的安全性和疗效。

方法

回顾性分析2014年1月至2018年5月在吉林大学中日联谊医院行PD的102例患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男57例，女45例；年龄27~78岁，中位年龄58岁。根据胰肠吻合方式不同，分为改良内陷式胰肠吻合组（改良组，48例）和胰管-空肠黏膜吻合组（对照组，54例）。比较两组围手术期情况。两组胰肠吻合时间、术中出血量、术后住院时间比较采用Wilcoxon秩和检验，术后并发症发生率比较采用χ2检验或Fisher确切概率法。

结果

改良组胰肠吻合时间、术中出血量、术后住院时间分别为25（9）min、350（100）ml、14（6）d，明显少于对照组的40（11）min、450（213）ml、20（9）d（Z=-7.840，-3.750，-4.790；P<0.05）。改良组术后胰瘘发生率为6%（3/48），明显低于对照组的26%（14/54） （χ2=5.738，P<0.05）；术后出血发生率为0，亦明显低于对照组的6%（3/54） （P=0.037）。

结论

改良内陷式胰肠吻合方式能明显降低PD术后胰瘘和出血发生率，缩短住院时间，改善患者预后，是一种简单、实用、安全可靠的胰肠吻合方式。

关键词: 胰十二指肠切除术, 胰管空肠吻合术, 手术后并发症, 胰瘘, 出血
Objective

To evaluate the safety and efficacy of modified invagination pancreaticojejunostomy (PJ) in pancreaticoduodenectomy (PD).

Methods

Clinical data of 102 patients undergoing PD in China-Japan Union Hospital of Jilin University from January 2014 to May 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 57 patients were male and 45 female, aged from 27 to 78 years, with a median age of 58 years. According to different procedures of PJ, all patients were divided into the modified invagination PJ group (modified group, n=48) and PJ group (control group, n=54). The perioperative conditions were compared between two groups. The PJ time, intraoperative blood loss and length of postoperative hospital stay were compared between two groups by Wilcoxon rank-sum test. The incidence of postoperative complications was statistically compared by Chi-square test or Fisher's exact test.

Results

In the modified group, the PJ time, intraoperative blood loss and length of postoperative hospital stay were25(9) min, 350(100) ml and 14(6) d, significantly less than 40(11) min, 450(213) ml and 20(9) d in the control group (Z=-7.840, -3.750, -4.790; P<0.05). The incidence of postoperative pancreatic fistula in the modified group was 6%(3/48), significantly lower than 26%(14/54) in the control group (χ2=5.738, P<0.05). The incidence of postoperative blood loss was 0 in the modified group, which was significantly lower than 6%(3/54) in the control group (P=0.037).

Conclusions

The modified invagination PJ can significantly reduce the incidence of pancreatic fistula and blood loss after PD, shorten the length of hospital stay and improve the clinical prognosis of patients. It is a simple, practical, safe and reliable procedure of PJ.

Key words: Pancreaticoduodenectomy, Pancreaticojejunostomy, Postoperative complications, Pancreatic fistula, Hemorrhage
表1 改良组和对照组胰十二指肠切除术患者一般情况比较
组别 例数 性别（例） 年龄（岁，±s） TB（μmol/L，±s） 原发病（例）
男 女 良性肿瘤 胰头癌 胆管末端癌 壶腹癌 十二指肠癌
改良组 48 27 21 57±11 354±78 3 29 8 4 4
对照组 54 30 24 58±12 321±65 2 26 13 7 6
统计值   χ2=0.403 t=-0.548 t=0.327 χ2=0.056
P值   0.379 0.613 0.751 0.763
表2 改良组和对照组胰十二指肠切除术患者围手术期情况比较
组别 例数 胰肠吻合时间[min，M（QR）] 术中出血量[ml，M（QR）] 主胰管直径（mm，±s） 术后住院时间[d，M（QR）]
改良组 48 25（9） 350（100） 2.97±0.03 14（6）
对照组 54 40（11） 450（213） 3.05±0.05 20（9）
统计值   Z=-7.840 Z=-3.750 t=-0.743 Z=-4.790
P值   0.006 0.004 0.805 0.015
表3 改良组和对照组胰十二指肠切除术患者术后并发症比较（例）
组别 例数 术后出血 胰瘘 胆漏 胃排空障碍 肺部感染
改良组 48 0 3 1 2 3
对照组 54 3 14 2 4 3
χ2值   - 5.738 0.082 0.067 0.001
P值   0.037 0.017 0.739 0.612 1.000
[1]
Diener MK, Hüttner FJ, Kieser M, et al. Partial pancreatoduodenectomy versus duodenum-preserving pancreatic head resection in chronic pancreatitis: the multicentre, randomised, controlled, double-blind ChroPac trial[J]. Lancet, 2017, 390(10099): 1027-1037.
[2]
Sülberg D, Chromik AM, Köster O, et al. Prevention and management of postoperative complications in pancreatic surgery[J]. Zentralbl Chir, 2010, 135(2):129-138.
[3]
Simon R. Complications after pancreaticoduodenectomy[J]. Surg Clin North Am, 2021, 101(5):865-874.
[4]
Wolfgang CL, Pawlik TM. Pancreaticoduodenectomy: time to change our approach?[J]. Lancet Oncol, 2013, 14(7):573-575.
[5]
Sachs TE, Tseng JF. Landmark series in pancreatic tumors: anastomotic techniques and route of reconstruction[J]. Ann Surg Oncol, 2021, 28(4):2227-2234.
[6]
Timmermann L, Bahra M, Pratschke J, et al. Development ofa novel dorsal incision only invagination type pancreatogastrostomy (Charité-PG) following open pancreaticoduodenectomy-a single centre experience[J]. J Clin Med, 2021, 10(12):2573.
[7]
Hines OJ, Windsor JA. Does pancreaticogastrostomy reduce the risk of postoperative pancreatic fistula after pancreatoduodenectomy?[J]. JAMA Surg, 2020, 155(4):321-322.
[8]
李斌, 罗祥基, 易滨, 等. 一种极简主义改良胰肠内陷式(Jiang式)吻合法的临床研究[J]. 中华肝胆外科杂志, 2017, 23(6):395-400.
[9]
Grobmyer SR, Kooby D, Blumgart LH, et al. Novel pancreaticojejunostomy with a low rate of anastomotic failure-related complications[J]. J Am Coll Surg, 2010, 210(1): 54-59.
[10]
Javed AA, Mirza MB, Sham JG, et al. Postoperative biliary anastomotic strictures after pancreaticoduodenectomy[J]. HPB, 2021, 23(11):1716-1721.
[11]
Ansorge C, Nordin JZ, Lundell L, et al. Diagnostic value of abdominal drainage in individual risk assessment of pancreatic fistula following pancreaticoduodenectomy[J]. Br J Surg, 2014, 101(2): 100-108.
[12]
Andrianello S, Pea A, Pulvirenti A, et al. Pancreaticojejunostomy after pancreaticoduodenectomy: suture material and incidence of post-operative pancreatic fistula[J]. Pancreatology, 2016, 16(1):138-141.
[13]
Wang M, Li D, Chen R, et al. Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours: a multicentre, open-label, randomised controlled trial[J]. Lancet Gastroenterol Hepatol, 2021, 6(6):438-447.
[14]
Tsuji M, Kimura H, Konishi K, et al. Management of continuous anastomosis of pancreatic duct and jejunal mucosa after pancreaticoduodenectomy: historical study of 300 patients[J]. Surgery, 1998, 123(6):617-621.
[15]
Hu BY, Leng JJ, Wan T, et al. Application of single-layer mucosa-to-mucosa pancreaticojejunal anastomosis in pancreaticoduodenectomy[J]. World J Gastrointest Surg, 2015, 7(11):335-344.
[16]
Hu BY, Wan T, Zhang WZ, et al. Risk factors for postoperative pancreatic fistula: analysis of 539 successive cases of pancreaticoduodenectomy[J]. World J Gastroenterol, 2016, 22(34): 7797-7805.
[17]
王捷, 朱玥, 殷子. 胰头十二指肠切除术的热点问题浅析[J/CD]. 中华肝脏外科手术学电子杂志, 2013, 2(3):141-145.
[18]
Folwarski M, Dobosz M, Małgorzewicz S, et al. Effects of Lactobacillus rhamnosus GG on early postoperative outcome after pylorus-preserving pancreatoduodenectomy: a randomized trial[J]. Eur Rev Med Pharmacol Sci, 2021, 25(1):397-405.
[19]
杨思捷, 张辉, 王正峰, 等. Braun吻合对胰十二指肠切除术后胃排空延迟的影响[J]. 临床肝胆病杂志, 2021, 37(7):1652-1656.
[20]
Peng SY, Mou YP, Liu YB, et al. Binding pancreaticojejunostomy: 150 consecutive cases without leakage[J]. J Gastrointest Surg, 2003, 7(7):898-900.
[21]
Ferencz S, Bíró Z, Vereczkei A, et al. Innovations in pancreatic anastomosis technique during pancreatoduodenectomies[J]. Langenbecks Arch Surg, 2020, 405(7):1039-1044.
[22]
Casciani F, Bassi C, Vollmer CM Jr. Decision points in pancreatoduodenectomy: insights from the contemporary experts on prevention, mitigation, and management of postoperative pancreatic fistula[J]. Surgery, 2021, 170(3):889-909.
[1] 杨倩, 李翠芳, 张婉秋. 原发性肝癌自发性破裂出血急诊TACE术后的近远期预后及影响因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 33-36.
[2] 李建美, 邓静娟, 杨倩. 两种术式联合治疗肝癌合并肝硬化门静脉高压的安全性及随访评价[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 41-44.
[3] 吴方园, 孙霞, 林昌锋, 张震生. HBV相关肝硬化合并急性上消化道出血的危险因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 45-47.
[4] 逄世江, 黄艳艳, 朱冠烈. 改良π形吻合在腹腔镜全胃切除消化道重建中的安全性和有效性研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 66-69.
[5] 杨体飞, 杨传虎, 陆振如. 改良无充气经腋窝入路全腔镜下甲状腺手术对喉返神经功能的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 74-77.
[6] 陈大敏, 曹晓刚, 曹能琦. 肥胖对胃癌患者手术治疗效果的影响研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 651-653.
[7] 陈航, 闵翔. 日间甲状腺切除术后出血的12例临床分析及应对措施[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 600-602.
[8] 罗佳, 赵晶晶, 曹小珍, 钟玲, 范林军, 曾令娟. 单侧腋窝双侧乳晕入路机器人甲状腺术后局部加压预防皮下隧道出血的对照研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 603-606.
[9] 潘冰, 吕少诚, 赵昕, 李立新, 郎韧, 贺强. 淋巴结清扫数目对远端胆管癌胰十二指肠切除手术疗效的影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 608-612.
[10] 林文斌, 郑泽源, 郑文能, 郁毅刚. 外伤性脾破裂腹腔镜脾切除术患者中转开腹风险预测模型构建[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 619-623.
[11] 崔佳琪, 吴迪, 陈海艳, 周惠敏, 顾元龙, 周光文, 杨军. TACE术后并发肝脓肿的临床诊治分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 688-693.
[12] 秦维, 王丹, 孙玉, 霍玉玲, 祝素平, 郑艳丽, 薛瑞. 血清层粘连蛋白、Ⅳ型胶原蛋白对代偿期肝硬化食管胃静脉曲张出血的预测价值[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 447-451.
[13] 高显奎, 赵太云, 陆兴俊, 张洪领, 房修罗, 闫碧春, 王胤, 王永翠, 刘苗苗, 冉若男. 内镜电凝止血与组织胶注射治疗上消化道溃疡伴出血的疗效观察[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 452-455.
[14] 张雯, 宋牡丹, 邓雪婷, 张云. 强化营养支持辅助奥曲肽治疗肝硬化合并食管胃底静脉曲张破裂出血的疗效及再出血危险因素[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 456-460.
[15] 姜里蛟, 张峰, 周玉萍. 多学科诊疗模式救治老年急性非静脉曲张性上消化道大出血患者的临床观察[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 520-524.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号