中国实用外科杂志2017，Vol.37Issue(1)：71-74,4.DOI:10.19538/j.cjps.issn1005-2208.2017.01.21
胰十二指肠切除术消化道重建方式个体化选择临床研究
Applicafion of individual selection strategy for pancreatico-digestive anastomosis after pancreaticoduodenectomy
摘要
Abstract
Objective To evaluate an individual strategy of pancreatic duct diameter-oriented for pancreaticoenteric anastomosis in pancreaticoduodenectomy. Methods A total of 119 patients with resectable tumour were undergone pancreaticoduodenectomy (PD) and conducted prospective randomized controlled study at the Department of Hepatobiliary and Pancreatic Surgery,People’s Hospital of Zhejiang Province and Institute of Biliary Pancreatic Surgery,Tongji Hospital,Tongji Medical College,Huazhong Scientific and Technological University. According to the size of pancreatic duct diameter (preoperative CT/MR and intraoperative measurement ),patients with duct diameter<3 mm and ≥3 mm were divided into two groups,and conducted improved binding pancreatogastrostomy (BPG group) occurred in 56 cases,and pancreatic duct to mucosa anastomosis (DM group) occurred in 63 cases,respectively. The clinical data of both groups were collected and analyzed retrospectively. Results The size of pancreatic duct were(2.3 ± 0.5)mm in BPG group and (5.0 ± 1.8)mm in DM group. The intraoperative data including operation time, pancreaticojejumostomy time and estimated blood loss were (353.4 ± 90.5)min, (25.7 ± 7.9)min and(457.1 ± 377.0)mL in BPG group and(395.6 ± 122.2)min ,(28.8 ± 5.6)min and(520.7 ± 218.5)mL in DM group. Complication occurred in 37%of patients and incidence of pancreatic fistula was 11.8%(14/119)in all patients, however, no grade C pancreatic fistula was detected. The rate of pancreatic fistula (grade B), postoperative bleeding, bile leakage, delayed gastric empty, gastrointestinal anastomotic leakage and intra-abdominal infection were 3.2%(2/56)、12.5%(7/56)、3.6%(2/56)、17.9%(10/56)、3.6%(2/56)、7.1%(4/56)and 3.2%(2/63)、7.9%(5/63)、3.2%(2/63)、6.3%(4/63)、1.6%(1/63)、4.8%(3/63) in BPG group and DM group respectively. Re-operative and readmission rate were 5.4%(3/56)and 3.6%(2/56)in BPG group and 3.2%(2/63)and 3.2%(2/63)in DM group. Serious complications (≥IIIa) occurred in 14.3%(8/56)patients in BPG group and 9.5%(6/63)patients in DM group. The length of postoperative hospital stay were(15.4 ± 6.9)d in BPG group and(13.2 ± 6.0)d in DM group. No mortality was found in both groups. Conclusion The individual strategy of pancreatic duct diameter-oriented for pancreaticoenteric anastomosis can reduce effectively the incidence of POPF and other severe complications in pancreaticoduodenectomy.关键词
胰十二指肠切除术/胰管直径/胰消化道重建/胰瘘Key words
pancreaticoduodenectomy/pancreatic duct diameter/pancreatic anastomosis/pancreatic fistula分类
医药卫生引用本文复制引用
洪德飞,秦仁义,王敏,卢毅,张宇华,张成武,孙晓东,吴伟顶..胰十二指肠切除术消化道重建方式个体化选择临床研究[J].中国实用外科杂志,2017,37(1):71-74,4.基金项目
浙江省科技厅重大专项资助（No.2013C03046）；浙江省卫计委重点学科重点资助 （）
