中国实用外科杂志

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (05): 564-569.DOI: 10.19538/j.cjps.issn1005-2208.2025.05.16

• 论著 • 上一篇    下一篇

胰十二指肠切除术“双线四针法”胰肠吻合安全性与有效性分析

梁月祥，高    松，王秀超，赵天锁，王    健，常少飞，王宏伟，高春涛，郝继辉   

  1. 天津医科大学肿瘤医院胰腺肿瘤科 国家恶性肿瘤临床医学研究中心 天津市肿瘤防治重点实验室，天津 300060
  • 出版日期:2025-05-01 发布日期:2025-05-28

  • Online:2025-05-01 Published:2025-05-28

摘要： 目的    探讨胰十二指肠切除术“双线四针法”胰肠吻合技术的临床应用效果，并比较开放手术与腹腔镜手术应用该胰肠吻合技术的差异。方法    回顾性分析2024年12月至2025年2月天津医科大学肿瘤医院胰腺肿瘤科行胰十二指肠切除术采用“双线四针法”胰肠吻合技术的连续35例病人的临床资料，分析所有病人围手术期指标，并比较开放组（19例）和腹腔镜组（16例）近远期结局差异。结果    所有病人平均胰肠吻合时间为（20.0±8.1） min，术后发生胰腺生化漏8例（22.9%），B级胰瘘1例（2.9%），无C级胰瘘发生。Clavien-Dindo并发症分级Ⅰ级3例，Clavien-Dindo并发症分级Ⅱ级5例，经保守治疗后好转，无Clavien-Dindo并发症分级 ≥Ⅲ级或死亡病例。所有病人中位带管时间为9.0（8.0，12.0） d，中位术后住院时间为12.0（10.0，15.0） d。腹腔镜组的胰肠吻合时间显著长于开放组［（27.8±3.8） min vs. （13.4±3.2） min，P<0.001］，术后住院时间明显短于开放组［10.5（10.0，13.0）d vs. 14.0（11.0，17.0）d，P=0.031），术后并发症Clavien-DindoⅡ级发生率显著低于开放组（0 vs. 26.3%，P=0.040），差异有统计学意义。结论    “双线四针法”胰肠吻合技术安全有效，开放及腹腔镜手术均适用。

关键词: 胰肠吻合, 胰十二指肠切除术, 胰瘘, 双线四针法

Abstract: To evaluate the clinical efficacy of the “double-suture four-needle technique” for pancreaticojejunostomy in pancreaticoduodenectomy, and compare the differences between the application of this pancreaticojejunostomy to open surgery and laparoscopic surgery. Methods    Clinical data of 35 consecutive patients undergoing pancreaticoduodenectomy with the “double-suture four-needle technique” at the Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, between December 2024 and February 2025 were retrospectively analyzed. Perioperative indicators of all patients were analyzed and the differences between the open group (19 cases) and the laparoscopic group (16 cases) were compared. Results    All pancreaticojejunostomies were successfully completed using the “double-suture four-needle technique”, with a mean anastomosis time of (20.0±8.1) min. Postoperative pancreatic fistula included biochemical pancreatic fistula in 8 cases (22.9%) and Grade B pancreatic fistula in 1 case (2.9%), with no Grade C pancreatic fistula. Clavien-Dindo grade Ⅰ complications occurred in 3 patients and grade Ⅱ complications occurred in 5 patients, all of which recovered with conservative management; no grade Ⅲ or higher complications or mortality were observed. The median tube indwelling time was 9.0 (8.0, 12.0) d, and median postoperative hospital stay was 12.0 (10.0, 15.0) d. The laparoscopic group demonstrated a longer pancreaticojejunostomy time ［(27.8±3.8) min vs. (13.4±3.2) min, P<0.001］, a shorter postoperative hospital stay ［10.5 (10.0, 13.0) d vs. 14.0 (11.0, 17.0) d, P=0.031)］ and a lower postoperative complication rate (0 vs. 26.3%, P=0.040) compared to the open surgery group, with statistically significant differences. Conclusion    The “double-suture four-needle technique” is a safe and effective method for pancreaticojejunostomy, suitable for both open and laparoscopic pancreaticoduodenectomy.

Key words: pancreatoenterostomy, pancreaticoduodenectomy, pancreatic fistula, double-suture four-needle technique