本文選題：胰十二指腸切除術(shù) + 胰腸吻合　； 參考：《遵義醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:探討利用大網(wǎng)膜包裹胰腸吻合口對(duì)胰十二指腸切除術(shù)后胰瘺發(fā)生及恢復(fù)情況的影響,評(píng)價(jià)該技術(shù)的實(shí)際臨床運(yùn)用效果。方法:回顧性分析四川省人民醫(yī)院肝膽胰脾外科細(xì)胞移植中心同一治療組2011年1月至2016年12月行胰十二指腸切除術(shù)(Pancreaticoduodenectomy,PD)77例病人的臨床資料。根據(jù)胰腸吻合口處理方式分為大網(wǎng)膜包裹組(31例)和非大網(wǎng)膜包裹組(46例)。其中大網(wǎng)膜包裹組男性18例,女性13例;年齡區(qū)間為31-76歲,平均年齡為62.58±10.39歲。非大網(wǎng)膜包裹組男性25例,女性21例;年齡區(qū)間為21-78歲,平均年齡為59.20±12.78歲。統(tǒng)計(jì)分析兩組病人術(shù)前一般資料(年齡、性別、體重指數(shù)、總膽紅素、白蛋白、腹部手術(shù)史、術(shù)前合并癥),術(shù)中一般資料(手術(shù)時(shí)間、出血量、輸血例數(shù)、胰腺質(zhì)地、胰管直徑等)及術(shù)后病理資料,術(shù)后并發(fā)癥資料(圍手術(shù)期死亡、胰瘺、出血、膽漏、腹腔積液、腹腔感染、腸梗阻、肺部感染、切口感染、多器官功能障礙),術(shù)后一般資料(ICU住院時(shí)間、胃管留置時(shí)間、引流管留置時(shí)間、術(shù)后住院時(shí)間、再次手術(shù)率等),觀察大網(wǎng)膜包裹胰腸吻合口預(yù)防胰十二指腸切除術(shù)后胰瘺發(fā)生及術(shù)后恢復(fù)情況,探討該技術(shù)的實(shí)際臨床效果。結(jié)果:1.大網(wǎng)膜包裹組與非包裹組術(shù)前一般資料(性別、年齡、體重指數(shù)、白蛋白、總膽紅素、腹部手術(shù)史、術(shù)前穿刺減黃例數(shù)及術(shù)前合并癥)比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2.大網(wǎng)膜包裹組與非包裹組術(shù)中一般資料(手術(shù)時(shí)間、出血量、輸血例數(shù)、胰液引流方式、胰腺質(zhì)地、胰管直徑)及術(shù)后病理資料比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3.大網(wǎng)膜包裹組術(shù)后并發(fā)癥8例(25.81%),非包裹組19例(41.30%);術(shù)后死亡5例(6.49%),其中大網(wǎng)膜包裹組1例(3.23%),非大網(wǎng)膜包裹組4例(8.70%)。大網(wǎng)膜包裹組與非包裹組在術(shù)后總并發(fā)癥率和死亡率比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。4.大網(wǎng)膜包裹組術(shù)后發(fā)生生化漏2例(6.46%),非包裹組11例(23.91%),兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。5.大網(wǎng)膜包裹組術(shù)后出現(xiàn)B級(jí)胰瘺1例(3.23%),C級(jí)胰瘺1例(3.23%);非包裹組術(shù)后B級(jí)胰瘺2例(4.35%),C級(jí)胰瘺2例(4.35%)。大網(wǎng)膜包裹組與非包裹組術(shù)后胰瘺發(fā)生率(B+C級(jí))比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。6.大網(wǎng)膜包裹組與非包裹組在術(shù)后出血(0.00%vs6.52%)、胃排空障礙(0.00%vs4.35%)、腹腔積液(6.45%vs19.57%)、腹腔感染(6.45%vs15.22%)、腸梗阻(0.00%vs2.17%)、多器官功能障礙(0.00%vs4.35%)等并發(fā)癥發(fā)生率比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。7.大網(wǎng)膜包裹組與非包裹組術(shù)后一般資料(ICU住院時(shí)間、術(shù)后輸血例數(shù)、胃管留置時(shí)間、引流管留置時(shí)間、術(shù)后住院時(shí)間、再次手術(shù)率)比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.大網(wǎng)膜包裹胰腸吻合口不能降低PD術(shù)后胰瘺(B、C級(jí))的發(fā)生率。2.大網(wǎng)膜包裹胰腸吻合口能降低術(shù)后生化漏的發(fā)生率,但對(duì)PD術(shù)后并發(fā)癥發(fā)生率及術(shù)后恢復(fù)無(wú)明顯影響。
[Abstract]:Objective: to investigate the effect of greater omentum encapsulated pancreaticojejunostomy on the occurrence and recovery of pancreatic fistula after pancreatoduodenectomy, and to evaluate the clinical effect of this technique.Methods: the clinical data of 77 cases of Pancreatic duodenectomy with Pancreatic duodenectomy were retrospectively analyzed in the same treatment group in the center of liver, bile, pancreas, pancreas and spleen surgery of Sichuan Provincial people's Hospital from January 2011 to December 2016.According to the management of pancreaticojejunostomy, there were 31 cases in omentum group and 46 cases in non-omentum group.There were 18 males and 13 females in the omentum group with an age range of 31-76 years (mean 62.58 鹵10.39 years).There were 25 males and 21 females in non-omentum group, the age range was 21-78 years, the average age was 59.20 鹵12.78 years.The preoperative general data (age, sex, body mass index, total bilirubin, albumin, history of abdominal surgery, preoperative complications, intraoperative data (time of operation, amount of blood loss, number of cases of blood transfusion, pancreatic texture) were analyzed statistically.Pancreatic duct diameter, postoperative pathological data, postoperative complications (perioperative death, pancreatic fistula, bleeding, bile leakage, peritoneal effusion, abdominal infection, intestinal obstruction, lung infection, incisional infection), postoperative complications (perioperative death, pancreatic fistula, bleeding, bile leakage, peritoneal effusion, abdominal infection, intestinal obstruction, lung infection, incisional infection),Multiple organ dysfunction, postoperative general data, ICU stay time, gastric tube retention time, drainage tube retention time, postoperative hospitalization time,To observe the prevention of pancreatic fistula and recovery after pancreatoduodenectomy with greater omentum wrapped pancreaticojejunostomy, and to explore the practical clinical effect of this technique.The result is 1: 1.There was no significant difference in preoperative data (sex, age, body mass index, albumin, total bilirubin, history of abdominal surgery, number of cases of preoperative yellow reduction and preoperative complications) between omentum group and unwrapped group (P 0.05. 2).There was no significant difference in general data (operation time, blood loss, blood transfusion, pancreatic fluid drainage, pancreatic texture, pancreatic duct diameter) and postoperative pathological data between the omentum encapsulation group and the unencapsulated group (P 0.05. 3).The postoperative complications were 25.81 in the omentum group and 41.30 in the unwrapped group, and the postoperative death was 6.49 in 5 cases, including 3.23 in the greater omentum group and 8.70 in the non-omentum wrapping group.There was no significant difference in the rate of postoperative complications and mortality between the omentum encapsulation group and the unencapsulated group (P 0.05. 4).Biochemical leakage occurred in 2 cases in the greater omentum group and in 11 cases in the unwrapped group. The difference between the two groups was statistically significant (P 0.05).In the group of greater omentum encapsulation, there were 1 case of grade B pancreatic fistula, 1 case of grade C fistula and 2 cases of grade B fistula, 2 cases of grade C fistula, and 2 cases of grade C fistula.There was no significant difference in the incidence of pancreatic fistula between the greater omentum encapsulation group and the unencapsulated group (P 0.05. 6).There was no significant difference in the incidence of complications between the greater omentum group and the unencapsulated group in postoperative hemorrhage (0.00vs6.52), gastric emptying disorder (0.00vs4.35m), peritoneal effusion (6.45vs19.57m), abdominal infection (6.45vs15.22g), intestinal obstruction (0.00vs2.17d), and multiple organ dysfunction (0.00vs4.35B).There was no significant difference in postoperative hospitalization time, blood transfusion cases, gastric tube indwelling time, drainage tube indwelling time, postoperative hospitalization time and reoperation rate between omentum encapsulation group and unwrapped group (P 0.05).Conclusion 1.Greater omentum encapsulation of pancreaticojejunostomy did not decrease the incidence of pancreatic fistula (grade C) after PD.Greater omentum encapsulation of pancreaticojejunostomy can reduce the incidence of postoperative biochemical leakage, but has no significant effect on the incidence of postoperative complications and postoperative recovery of PD.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R657.5

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