中国实用外科杂志

中国实用外科杂志

• 论著 • 上一篇    下一篇

改良胆肠内支撑外引流在胰十二指肠切除术中细口径胆肠吻合中的应用

郑楷炼，时霄寒，王    斐，白思嘉，郭世伟，刘仁东，张怡杰，金    钢   

  1. 第二军医大学附属长海医院胰腺外科，上海 200433
  • 出版日期:2017-02-01 发布日期:2017-01-24

  • Online:2017-02-01 Published:2017-01-24

摘要：

目的    探讨胰十二指肠切除术中细口径胆肠吻合使用改良的T管支撑引流的安全性和有效性。方法    回顾性分析2009年8月至2014年8月第二军医大学附属长海医院胰腺外科行胰十二指肠切除术的胆管直径<8 mm、胰管直径正常的166例病人资料，其中81例病人采用改良的T管支撑引流胆肠吻合（改良组），85例病人采用直接胆肠吻合（常规组），比较分析两组胆瘘、胰瘘发生率及其他手术相关指标的差异。结果  改良组病人在术后胰瘘、胆瘘的发生率，术中出血量及住院时间，术后胆肠吻合口狭窄发生率均低于常规组（P均＜0.05）。结论    改良的T管支撑引流胆肠吻合操作简便，在降低胰瘘、胆瘘发生率方面有优势，同时存在术中出血少，住院时间短及术后胆肠吻合口狭窄发生率低等优点，是胰十二指肠切除术中胆肠吻合的一种有效的改良方案，值得临床推广应用。

关键词: 胆肠吻合术, T管支撑引流, 胰十二指肠切除术, 胆瘘, 胰瘘

Abstract:

Application of optimized T-tube support drainage in cholangioenterostomy of pancreaticoduodenectomy                    ZHENG Kai-lian, SHI Xiao-han, WANG Fei, et al. Department of HBP Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433,China
Corresponding authors: JIN Gang, E-mail：jingang@sohu.com; ZHANG Yi-jie, E-mail: yijie06@medmail.com.cn
Abstract    Objective    To investigate the practicability, safety and availability of optimized T-tube support drainage in cholangioenterostomy of pancreaticoduodenectomy for small-diameter (diameter<8mm) bile duct. Methods    The clinical data of 166 cases of small-diameter bile duct (diameter <8mm) and normal pancreatic duct, who underwent pancreaticoduodenectomy in Department of HBP Surgery, Changhai Hospital, the Second Military Medical University from August 2009 to August 2014  were analyzed retrospectively. The incidences of biliary fistula, pancreatic fistula and other surgical indicators of optimized T-tube support drainage group (optimization group, n=81) and conventional cholangioenterostomy group (conventional group, n=85) were compared. Results    In the optimization group, the incidences of posteprative biliary and pancreatic fistula, bleeding volume in operation, length of stay and postoperative stenosis rate of cholangioenterostomy were lower than those of the conventional group, and the two groups had statistical significance (all P<0.05). Conliusion    The optimized T-tube support drainage of cholangioenterostomy is easy to operate with advantages of reducing pancreatic and biliary fistula. Furthermore, there is less bleeding, shorter length of stay and lower postoperative recurrence of stenosis rate of cholangioenterostomy, etc., which is an efficient optimization scheme in cholangioenterostomy of pancreaticoduodenectomy, and is worthy of clinical popularization and application.

Key words: cholangioenterostomy, T-tube support drainage;pancreaticoduodenectomy, biliary fistula, pancreatic fistula