中国实用外科杂志

中国实用外科杂志

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远端胰腺切除术中两种胰腺残端封闭技术对比研究

欧阳柳，臧    慧，张全群，刘    彻，宋    彬，邵    卓，李    刚，周旭宇，胡先贵，金    钢   

  1. 第二军医大学附属长海医院，上海200433
  • 出版日期:2016-06-01 发布日期:2016-05-31

  • Online:2016-06-01 Published:2016-05-31

摘要：

目的    对比远端胰腺切除术中两种胰腺残端封闭技术的疗效，为胰腺外科手术医生选择合理的胰腺残端封闭技术提供参考。方法    回顾性分析2012-01-01至2013-09-30因“胰体尾占位性病变”在第二军医大学附属长海医院胰腺外科行开放的远端胰腺切除术的部分病人资料，分为切割闭合器组（99例）和手工缝合组（57例），对比两组之间术中、术后及随访情况。结果    两组病人性别、年龄、体重指数、手术时间、术中出血、术中输血量、引流液淀粉酶值及胰瘘、术后输血率、术后体温（T）≥38℃、术后心率≥100次/min、术后再次手术、术后住院天数、术后30 d内再住院率及术后30 d内病死率差异均无统计学意义；术后输血量和总住院费用手工缝合组均少于切割闭合器闭合组，两组之间差异有统计学意义（P<0.05）。结论    建议胰腺外科医生在行开放的远端胰腺切除术时优先考虑选用手工缝合的方法来封闭保留侧胰腺残端。

关键词: 远端胰腺切除术, 切割闭合器, 缝合, 胰瘘

Abstract:

Contrast study of the closure methods of the pancreatic remnant in distal pancreatectomy        OUYANG Liu, ZANG Hui, ZHANG Quan-qun, et al. Department of Pancreatic Surgery, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai 200433, China
Corresponding author: JIN Gang, E-mail:jingang@sohu.com
Abstract    Objective    To compare the advantages and disadvantages of two closure methods of the pancreatic remnant in distal pancreatectomy，and then help the pancreatic surgeon to choose the correct closure method to deal with the pancreatic remnant in distal pancreatectomy. Methods    The clinical data of 156 patients received the distal pancreatectomy for“the neoplasm in the body or tail of the pancreas” admitted in Changhai Hospital Affiliated to the Second Military Medical University between January 1st，2012 and September 30th，2013 were analyzed retrospectively. All the patients were divided into two groups, the staple group (99 patients) and the hand suture group (57 patients). The intraoperative，postoperative and follow-up information of all the patients were collected comprehensively and all the data collected were analyzed statistically. Results    There were not statistically significant difference of the gender，age，body mass index (BMI)，operation time，intraoperative bleeding，intraoperative blood transfusion，the amylase value of the fluid of drainage，pancreatic fistula，the ratio of postoperative blood transfusion，body temperature≥38℃，postoperative heart rate≥100 bpm，reoperation，length of postoperative hospital stay，readmission within 30 days after the operation and death within 30 days after the operation. There were statistically significant difference of the quantity of the postoperative blood transfusion and total hospitalization cost between the two groups（P<0.05）. The hand-sewn closure method group was less than the stapler method group in both of them. Conclusion    In the open distal pancreatectomy，it is suggested that the pancreatic surgeon should choose the hand-sewn closure method to deal with the preserved remnant of the pancreas.

Key words: distal pancreatectomy, stapler, suture, pancreatic fistula