中国实用外科杂志

中国实用外科杂志 ›› 2022, Vol. 42 ›› Issue (05): 561-568.DOI: 10.19538/j.cjps.issn1005-2208.2022.05.17

• 论蓍 • 上一篇    下一篇

腹腔镜胰十二指肠切除术后胃排空延迟原因分析及处理

刘    军，徐延田，孔俊杰，李光兵，于光圣，郑顺贞，曹昱琨，王建平，郑元文，司    伟，杨凤辉，李春友，许世峰，公    伟，孟凡迎，贺竞毅   

  1. 山东第一医科大学附属省立医院器官移植肝胆外二科，山东济南 250021
  • 出版日期:2022-05-01 发布日期:2022-05-17

  • Online:2022-05-01 Published:2022-05-17

摘要： 目的    探讨腹腔镜胰十二指肠切除术（LPD）后胃排空延迟（DGE）发生原因及处理要点。方法    回顾性分析2017年3月至2021年11月山东第一医科大学附属省立医院器官移植肝胆外二科832例行LPD病人临床资料，根据是否发生DGE分为DGE组和无DGE组，比较两组病人临床特征，logistic回归分析DGE发生的危险因素，评估不同处理方式的效果。结果    共有194例（23.3%）术后发生DGE。与无DGE组比较，DGE组术前低白蛋白血症病例多，手术时间长，术中出血量多，行改进前胃空肠吻合和术中输血例数多，术后并发症发生率高，其中Clavien-Dindo分级≥Ⅲa级并发症，胆漏，B、C级胰瘘和腹腔感染发生率高于无DGE组。多因素logistic回归分析发现术前低白蛋白血症、术中输血和腹腔感染是任意级别DGE发生的独立危险因素；其中术中输血、胰瘘、胆漏和腹腔感染是B、C级DGE发生的独立危险因素。B、C级DGE 62例，48例存在腹腔感染合并吻合口漏，其中42例接受腹腔穿刺引流，6例持续内冲洗负压引流，均取得良好治疗效果。结论    DGE多继发于术后吻合口漏及腹腔感染，术前纠正低白蛋白血症、合理的胃空肠吻合、减少吻合口漏、通畅引流对预防及治疗DGE具有重要作用。

关键词: 腹腔镜胰十二指肠切除术, 胃排空延迟, 术后并发症, 危险因素

Abstract: Risk factors and treatment strategies of delayed gastric emptying after laparoscopic pancreaticoduodenectomy           LIU Jun, XU Yan-tian, KONG Jun-jie, et al. Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
Corresponding author: LIU Jun, E-mail: dr_liujun1967@126.com
Abstract    Objective    To explore the risk factors and key points of management of delayed gastric emptying (DGE) after laparoscopic pancreaticoduodenectomy (LPD). Methods    The clinical data of 832 patients who underwent LPD in the Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University between March 2017 and November 2021 were analyzed retrospectively. According to the occurrence of DGE, patients were divided into the DGE group and the non-DGE group. The clinical characteristics of the two groups were compared, the risk factors for DGE were analyzed, and the effects of various treatment strategies were evaluated. Results    A total of 194 (23.3%) patients developed DGE after LPD. Compared with those in the non-DGE group, patients in the DGE group had more preoperative hypoalbuminemia, longer operative time, more intraoperative blood loss, more modified gastrojejunal anastomosis, and blood transfusion, and a higher incidence of postoperative complications. Furthermore, they also had more Clavien-Dindo grade IIIa or higher, postoperative complications, bile leakage, grade B/C pancreatic fistula and intra-abdominal infection. Multivariate logistic regression analysis showed that preoperative hypoalbuminemia, intraoperative blood transfusion and intra-abdominal infection were independent risk factors for DGE; furthermore, intraoperative blood transfusion, postoperative pancreatic fistula, bile leakage and intra-abdominal infection were independent risk factors for grade B and C DGE. Sixty-two patients developed grade B and C DGE, 48 of whom had intra-abdominal infection combined with anastomosis leakage. Among them, 42 patients underwent abdominal puncture drainage, and 6 received continuous internal negative pressure flushing and drainage, and all of them recovered rapidly after treatment. Conclusion    Postoperative anastomosis leakage combined with intra-abdominal infection is the main cause of DGE after LPS. Treatment of preoperative hypoalbuminemia, rational gastrojejunal anastomosis, reducing the occurrence of anastomosis leakage, and keeping drain is important for the prevention and treatment of DGE.

Key words: laparoscopic pancreaticoduodenectomy, delayed gastric emptying, postoperative complication, risk factor