本文選題：胰十二指腸切除術(shù) + 胰腸吻合　； 參考：《吉林大學》2017年碩士論文

【摘要】：目的探討胰腺空腸端端套入式間斷U型縫合法在胰十二指腸切除術(shù)中的應用價值。方法回顧性分析2006年8月至2016年6月我科收治的263例行胰十二指腸切除術(shù)患者的臨床資料,根據(jù)吻合方式分為胰腺空腸端端套入式間斷U型縫合組和胰管-空腸粘膜端側(cè)胰腸吻合組。U型吻合組患者176例,胰管-空腸粘膜吻合組患者87例,兩組患者的一般資料相比,差異無統(tǒng)計學意義(P0.05),具有可比性。觀察兩組患者手術(shù)時間、術(shù)中出血量和輸血量、術(shù)后引流管拔除時間、術(shù)后住院時間以及胰瘺、腹腔內(nèi)感染、腹腔出血、膽瘺、胃排空延遲和死亡等指標發(fā)生率的差異。服從正態(tài)分布的計量資料以均數(shù)±標準差即((?)±s)形式表示,并采用t檢驗。不服從正態(tài)分布的計量資料以中位數(shù)(四分位間距)即M(Q)形式表示,并采用秩和檢驗。計數(shù)資料采用c2檢驗,對部分結(jié)果應用Fisher精確概率法檢驗。P0.05為差異有統(tǒng)計學意義。結(jié)果U型吻合組患者手術(shù)時間5.50(1.00)h明顯低于胰管-空腸粘膜吻合組患者7.00(2.75)h(P0.05)。U型吻合組患者術(shù)中出血量300.00(400.00)ml明顯低于胰管-空腸粘膜吻合組患者400.00(500.00)ml(P0.05)。263例患者術(shù)后總體胰瘺發(fā)生率7.6%,其中U型吻合組患者胰瘺發(fā)生率5.1%。胰管-空腸粘膜吻合組患者胰瘺發(fā)生率12.6%。U型吻合組患者術(shù)后胰瘺發(fā)生率和B級胰瘺發(fā)生率明顯低于胰管-空腸粘膜吻合組患者(P0.05),兩組患者A級和C級胰瘺發(fā)生率差異無統(tǒng)計學意義(P0.05)。兩組患者術(shù)中輸血量、術(shù)后引流管拔除時間、術(shù)后住院時間以及其他主要術(shù)后并發(fā)癥發(fā)生率差異無統(tǒng)計學意義(P0.05)。結(jié)論胰腺空腸端端套入式間斷U型縫合法操作簡單,吻合安全,可以有效降低PD術(shù)后胰瘺特別是較嚴重胰瘺的發(fā)生率,同時不會增加患者術(shù)后的身體和經(jīng)濟負擔,具有較大的臨床應用價值。
[Abstract]:Objective to evaluate the value of discontinuous U-suture at the end-to-end of pancreas jejunum in pancreaticoduodenectomy. Methods the clinical data of 263 cases of pancreaticoduodenectomy treated in our department from August 2006 to June 2016 were analyzed retrospectively. According to the anastomosis mode, 176 cases were divided into two groups: pancreatic jejunal end to end insertion discontinuous U suture group, pancreatic duct jejunum mucosal end to side pancreaticojejunostomy group, and pancreatic duct jejunum mucosal anastomosis group, 87 cases. The general data of the two groups were compared. The difference was not statistically significant (P 0.05) and was comparable. The time of operation, the amount of blood loss and blood transfusion, the time of extubation of drainage tube, the time of hospitalization, the incidence of pancreatic fistula, intraperitoneal infection, intraperitoneal hemorrhage, biliary fistula, gastric emptying delay and death were observed between the two groups. The measurement data of normal distribution were expressed in the form of mean 鹵standard deviation (鹵s), and t test was used. The measurement data from normal distribution are expressed in the form of median (quartile spacing) or MQs, and rank sum test is used. The counting data were measured by c2 test, and Fisher exact probability test was used to test some results. The difference was statistically significant. Results the operative time of patients with U-type anastomosis was significantly lower than that of patients with pancreaticojejunostomy (5.50 ~ 1.00 h) compared with that of patients with pancreatic duct and jejunal mucosal anastomosis (7.00 ~ 2.75) (P 0.05) .U type anastomosis group was significantly lower than that of pancreatic duct and jejunal mucosal anastomosis group (400.0050). The incidence of pancreatic fistula was 5.1 in U type anastomosis group. The incidence of pancreatic fistula in the pancreatic duct jejunum anastomosis group was significantly lower than that in the pancreatic duct jejunum mucosal anastomosis group (P 0.05). The incidence of pancreatic fistula in the U type anastomosis group was significantly lower than that in the pancreatic duct jejunal mucosal anastomosis group (P 0.05). The difference was not statistically significant (P 0.05). There was no significant difference in the amount of blood transfusion, the time of extubation, the time of hospitalization and the incidence of other major postoperative complications between the two groups (P 0.05). Conclusion the operation of discontinuous U-type suture at the end of jejunum of pancreas is simple and safe, which can effectively reduce the incidence of pancreatic fistula, especially severe pancreatic fistula, without increasing the body and economic burden of the patients after PD. It has great clinical application value.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R657.5

【相似文獻】

相關(guān)期刊論文 前1條

1 卡索,劉成,陳向軍,關(guān)志明;U型縫合法一期修復指屈肌腱損傷[J];骨與關(guān)節(jié)損傷雜志;2000年02期

相關(guān)碩士學位論文 前2條

1 項一恩;胰腺空腸端端套入式間斷U型縫合法在胰十二指腸切除術(shù)中的應用[D];吉林大學;2017年

2 宣巍;胰腺—空腸端端套入式間斷U型縫合法吻合在胰腺外科中的應用[D];吉林大學;2006年

，

本文編號：1993416