本文選題：胰十二指腸切除術 + 胰腸吻合術�。� 參考：《鄭州大學》2017年碩士論文

【摘要】：背景和目的:胰十二指腸切除術是治療膽管下端腫瘤、壺腹周圍癌、十二指腸惡性腫瘤、胰頭癌的主要手術切除方式。而胰十二指腸切除術手術之后的一些并發(fā)癥如胰瘺、出血、膽瘺、胃排空障礙等會嚴重影響手術的效果,一些嚴重的并發(fā)癥甚至會威脅病人的生命。最相關的并發(fā)癥是胰瘺,不同研究機構其發(fā)生率也不同一般波動在2%至24%之間,胰瘺是胰十二指腸切除術中的難點問題甚至關乎著手術的成敗,研究表明胰十二指腸切除術術后胰瘺相關死亡率接近10%。胰瘺的出現(xiàn)與否受到許多因素的影響,包括一些不可改變的內在因素如性別、年齡、體重指數(shù)等,但是其影響因素還包括一些可控因素如胰腸吻合重建的方式、圍手術期的管理、外科操作技術水平、手術切除范圍等,其中胰腸重建的方式是其中一個重要影響因素。胰腸吻合的方式從胰十二指腸切除術誕生以來不斷演變,其方式可謂多種多樣,但是截至目前,最佳的重建方式尚無定論,這個領域頗具爭議。我中心致力于胰腸重建方式的研究,在傳統(tǒng)端側吻合方式的基礎上創(chuàng)立了一種新的吻合方式?胰管對空腸黏膜連續(xù)板層胰腸吻合術,根據(jù)臨床觀察,這種吻合方式臨床效果比較滿意,本研究旨在驗證其臨床應用效果,并比較和探討該吻合方式與胰腸端端套入吻合方式對人體應激反應的差異。材料和方法:回顧性研究分析2011年1月至2015年12月在本院因惡性腫瘤行胰十二指腸切除術的168例病人的病歷資料,在所有病人中86例患者行胰管對空腸黏膜連續(xù)板層胰腸吻合術(實驗組),82例患者行傳統(tǒng)的胰腺空腸端端套入吻合術(對照組)。比較實驗組、對照組兩組病人手術前一般狀況、手術中情況、手術后情況以及手術后并發(fā)癥的發(fā)生情況,并比較這兩組患者手術后第一天、手術后第三天及手術后一周的CRP、白細胞計數(shù)、中性粒細胞比例等應激檢驗指標。結果:胰管對空腸黏膜連續(xù)板層胰腸吻合組(實驗組)與胰腺空腸端端套入吻合組(對照組)的性別、年齡、ASA分級、BMI、伴發(fā)疾病情況、既往腹部手術史、手術前膽道引流情況、手術病因類型、術前實驗室檢測指標、胰管直徑、胰腺質地各指標差異無統(tǒng)計學意義(P0.05);實驗組的胰腸吻合時間、手術中出血量、手術后進食時間、手術后住院時間、住院總花費明顯低于對照組,差異有統(tǒng)計學意義(P0.05);實驗組術后胰瘺的發(fā)生率顯著低于對照組,差異有統(tǒng)計學意義(P0.05);實驗組、對照組兩組間腹腔出血、腹痛、高熱、胃排空障礙、切口感染并發(fā)癥發(fā)生率無顯著性差異(P0.05);實驗組與對照組兩組再次手術、圍手術期死亡臨床結局指標比較差異無統(tǒng)計學意義(P0.05);實驗組手術后第一天、手術后第三天、手術后一周的白細胞計數(shù)、中性粒細胞比例、CRP應激指標顯著優(yōu)于對照組,差異有統(tǒng)計學意義(P0.05)。結論:胰管對空腸黏膜連續(xù)板層式胰腸吻合方法在胰十二指腸切除術中應用的短期效果比較滿意,但是該吻合方法臨床應用的例數(shù)少,其治療效果還有待進一步的隨機對照試驗和大宗病例分析進一步證實。
[Abstract]:Background and objective: pancreatoduodenectomy is a major surgical procedure for the treatment of lower bile duct tumors, periampullary carcinoma, malignant duodenal tumor, and pancreatic head carcinoma. The complications such as pancreatic fistula, bleeding, biliary fistula, and gastric emptying obstruction after pancreatoduodenectomy will seriously affect the effect of the operation, and some serious complications are complicated. The disease may even threaten the life of the patient. The most related complication is the pancreatic fistula, and the incidence of the different research institutions varies from 2% to 24%. The pancreatic fistula is a difficult problem in the pancreatoduodenectomy, even the success or failure of the operation. The study shows that the mortality of pancreatic fistula related to pancreatic fistula after pancreatoduodenectomy is close to the 10%. pancreatic fistula. There are many factors affecting the presence or not, including some unaltered internal factors such as sex, age, and body mass index, but the influencing factors include some controllable factors such as the way of reconstruction of the pancreas and intestines, the management of the perioperative period, the level of surgical operation and the range of hand resection, among which the way of the reconstruction of the pancreas is one of them. The mode of Pancreatoenterostomy has evolved since the birth of pancreatoduodenectomy, and its way is varied. However, the best way of reconstruction is not conclusive as of now. This field is quite controversial. My center is devoted to the study of the way of pancreas bowel reconstruction and founded a traditional way of end to side anastomosis. A new anastomosis of the pancreatic duct to the continuous lamellar pancreaticojejunostomy of the jejunum mucosa, according to clinical observation, the clinical effect of this anastomosis is satisfactory. The purpose of this study is to verify its clinical effect, and to compare and explore the difference between the anastomosis and the end of the Pancreaticoenterostomy on human stress response. Materials and methods: Retrospective From January 2011 to December 2015, 168 patients who underwent pancreatoduodenectomy due to malignant tumor were analyzed in our hospital. In all the patients, 86 patients underwent pancreatic duct to jejunum mucosa continuous lamellar pancreaticojejunostomy (experimental group), and 82 patients underwent traditional end-to-end anastomosis of the pancreas jejunum (control group). The experimental group was compared with the experimental group. The general condition of the two groups before operation, the operation situation, the postoperative situation and the occurrence of postoperative complications were compared, and the CRP, white blood count and neutrophils ratio of the two groups were compared on the first day after operation, third days after operation, and the ratio of neutrophils in the first week after operation. The sex, age, ASA classification, BMI, associated disease, previous history of abdominal surgery, preoperative biliary drainage, surgical etiological types, preoperative laboratory test indexes, pancreatic duct diameter and pancreatic texture were not statistically significant (P0.05) in the group of intestinal anastomosis group (experimental group) and the concomitant group (control group); the pancreatic duct was not statistically significant (P0.05); the pancreas of the experimental group was not significant. The time of intestinal anastomosis, the amount of bleeding in the operation, the time of eating after the operation, the time of hospitalization after the operation, the total cost of hospitalization were significantly lower than that of the control group (P0.05). The incidence of pancreatic fistula in the experimental group was significantly lower than that of the control group (P0.05); the experimental group and the control group were two groups of abdominal bleeding, abdominal pain, high fever, gastric emptying. There was no significant difference in the incidence of complications in the incision infection (P0.05). There was no significant difference between the two groups in the experimental group and the control group, and there was no significant difference in the perioperative mortality index (P0.05), the first day after the operation, the third day after the operation, the leukocyte count, the proportion of neutrophils, and the CRP stress index at one week after the operation. Compared with the control group, the difference was statistically significant (P0.05). Conclusion: the short term effect of the continuous lamellar pancreaticojejunostomy anastomosis in the jejunum mucosa in the pancreatoduodenectomy is satisfactory, but the clinical application of this anastomosis method is less, and the therapeutic effect of this method is still to be further randomized controlled trial and large case analysis. Further confirmation.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R656

【參考文獻】

相關期刊論文 前10條

1 陳梅福;謝陽云;李國光;李云峰;梁路峰;鄒方;羅驍;;雙U套入荷包捆綁式胰腸吻合術預防胰液漏的療效分析[J];中華消化外科雜志;2016年10期

2 邊偉;杜成旭;李冬瑞;劉三光;王文斌;劉建華;;胰十二指腸切除術中序貫式胰腸端側吻合的臨床研究[J];河北醫(yī)科大學學報;2016年05期

3 沈正超;王小明;;胰十二指腸切除術中胰腸吻合術式的現(xiàn)狀與進展[J];中國現(xiàn)代普通外科進展;2016年02期

4 李正杰;張雷;;胰十二指腸切除術胰腸吻合方法新進展[J];中國醫(yī)師進修雜志;2016年02期

5 王錚;雷建軍;徐軍;馬清涌;仵正;;連續(xù)貫穿端側胰腸吻合術的臨床觀察[J];中華外科雜志;2016年01期

6 朱沙俊;朱銘巖;王志偉;;緊貼式胰空腸吻合在108例胰十二指腸切除術中的應用[J];南通大學學報(醫(yī)學版);2015年05期

7 樓文暉;;胰瘺診斷標準、分級評價及修改建議[J];中國實用外科雜志;2015年08期

8 胡丙洋;冷建軍;萬濤;董家鴻;顧萬清;黃曉強;王敬;紀文斌;陳明易;王彥斌;張文智;;511例胰十二指腸切除術患者胰瘺危險因素分析[J];中華肝膽外科雜志;2015年06期

9 顏丙松;欒曉琳;姬文超;陳宗凱;李娜;李文超;孫傳東;;胰十二指腸切除術不同胰腸吻合方式的選擇與效果評價[J];肝膽胰外科雜志;2015年02期

10 苗毅;張?zhí)?孫備;樓文暉;;胰腺切除術后消化道重建技術專家共識[J];中國實用外科雜志;2014年03期

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