中国实用外科杂志

中国实用外科杂志

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“镶嵌式”胰肠吻合法在胰十二指肠切除术中的应用（附150例分析）

吕    洋，张    磊，李剑昂，辛宝宝，楼文晖，靳大勇，许雪峰   

  1. 复旦大学附属中山医院普外科 复旦大学普外科研究所，上海 200032
  • 出版日期:2017-05-01 发布日期:2017-04-28

  • Online:2017-05-01 Published:2017-04-28

摘要：

目的    探讨“镶嵌式”胰肠吻合法对胰十二指肠切除术（PD）术后主要并发症（胰瘘、胆瘘以及胃排空延迟等）发生率的影响。方法    回顾性分析2013年8月到2015年12月复旦大学附属中山医院胰腺外科连续收治的150例因胰头或壶腹周围肿瘤行PD病人的临床资料，所有病人均采取“镶嵌式”胰肠吻合法。观察病人术后30 d内胰瘘的发生率和级别，以及胆瘘、胃排空延迟、出血和死亡的发生率。结果    150例病人中，30例(20%)发生胰瘘，其中A级胰瘘22例（14.7%），B级胰瘘8例（5.3%），无C级胰瘘发生；3例（2.0%）出现术后胆瘘；5例（3.3%）出现术后胃排空延迟；无术后出血及手术死亡病例。结论    “镶嵌式”胰肠吻合法原理清晰，操作简单，有效减少了PD术后严重胰瘘和出血的发生，提高了PD的安全性。

关键词: 胰十二指肠切除术, 胰肠吻合, 并发症, 胰瘘

Abstract:

The clinical application of “embeddedness-like” pancreaticojunostomy on the pancreaticoduodenectomy：An analysis of 150 cases        LÜ Yang, ZHANG Lei, LI Jian-ang, et al. Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Corresponding author: XU Xue-feng,E-mail:xuefengxu87@aliyun.com
Abstract    Objective    To investigate the effect of “embeddedness-like” pancreaticojunostomy on the incidence of major complications (pancreatic fistula, biliary fistula and delayed gastric emptying) after pancreatoduodenectomy (PD). Methods    The data of 150 cases of PD admitted from August 2013 to December 2015 in Zhongshan Hospital, Fudan University were analyzed. All surgeries were performed "embeddedness-like" pancreaticojunostomy. The general information, disease status, and the occurrence rate of postoperative complications (including postoperative pancreatic fistula, biliary leakage, delayed gastric emptying, bleeding and death) within 30 days after the surgery were observed. Results    Among 150 cases, there were 30 cases had postoperative pancreatic fistula (POPF) (20%), the proportion of Grade A, B and C was 14.7% (n=22), 5.3% (n=8) and 0, respectively. A total of 2% (n=3) of the cases had the biliary fistula and 3.3% (n=5) appeared delayed gastric emptying (DGE). Furthermore, no postoperative bleeding and operative deaths occurred. Conclusion    The application of the “embeddedness-like” pancreaticojunostomy is safe and effective in pancreaticoduodenectomy, and could validly reduce the incidence of POPF and bleeding.

Key words: pancreaticoduodenectomy, pancreaticojunostomy, complication, pancreatic fistula