本文選題：胰頭十二指腸切除術(shù) + 胰管空腸黏膜吻合術(shù)　； 參考：《河北醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:胰頭十二指腸切除術(shù)(pancreatoduodenetomy,PD)是主要用于治療胰頭部、膽總管末端及十二指腸乳頭、壺腹部等良惡性疾病的經(jīng)典術(shù)式,PD涉及臟器多,操作時(shí)間長(zhǎng),術(shù)中出血多,技術(shù)難度大,是腹部外科挑戰(zhàn)性最大的手術(shù)之一。盡管近年胰腺外科領(lǐng)域取得了很大的進(jìn)步,手術(shù)技術(shù)不斷改進(jìn),護(hù)理水平不斷提高,該術(shù)式的死亡率目前已降至5%左右,然而,其術(shù)后并發(fā)癥的發(fā)生率仍然高達(dá)30%~60%。其中胰瘺(pancreatic fistula,PF)是最常見(jiàn)、最危險(xiǎn)的并發(fā)癥之一,其發(fā)生率在2%~20%。本研究旨在探討胰管空腸黏膜Prolene線連續(xù)吻合技術(shù)在胰腸吻合中的應(yīng)用價(jià)值。方法:回顧性分析2013年6月至2015年6月在河北醫(yī)科大學(xué)第四醫(yī)院肝膽外科行胰頭十二指腸切除術(shù)的165例病人的臨床資料,其中行胰管空腸黏膜Prolene線連續(xù)吻合術(shù)的病人53例,采用普通嵌套式胰腸吻合的病人112例。比較兩組間胰瘺的發(fā)生率有無(wú)顯著性差異。統(tǒng)計(jì)學(xué)分析應(yīng)用SPSS 21.0統(tǒng)計(jì)軟件包進(jìn)行,統(tǒng)計(jì)分析采用χ2檢驗(yàn),以P0.05為差異有顯著性。結(jié)果:施行胰頭十二指腸切除術(shù)的全部165例病歷資料中,有69例發(fā)生術(shù)后并發(fā)癥(發(fā)生率41.8%),其中主要并發(fā)癥為腹腔感染(36例,發(fā)生率21.8%),胰瘺(19例,發(fā)生率11.5%),消化道出血(17例,發(fā)生率10.3%);手術(shù)期死亡2例(死亡率1.2%)。行胰管空腸黏膜Prolene線連續(xù)吻合術(shù)的53例病人,術(shù)后僅2例發(fā)生胰瘺,且均為A級(jí),經(jīng)抑酶等對(duì)癥治療后,胰瘺均消失,胰瘺發(fā)生率為3.8%(2/53);而采用普通嵌套式胰腸吻合的112例病人,術(shù)后有17例發(fā)生胰瘺,胰瘺發(fā)生率為15.2%(17/112),兩組間差異具有顯著性(χ2=4.493,P=0.037)。結(jié)論:胰管空腸黏膜Prolene線連續(xù)吻合技術(shù)是采取連續(xù)吻合主胰管及空腸全層,吻合確切,不易發(fā)生胰瘺,受胰腺質(zhì)地影響較小,且Prolene線針線一體,線體光滑,摩擦力較小,適于連續(xù)吻合。此吻合方式便捷可行,能明顯降低胰瘺的發(fā)生率,是一種安全可行的吻合方式。
[Abstract]:Objective: Pancreatoduodenetomyus (PDD) is a classic procedure for the treatment of benign and malignant diseases such as the head of pancreas, the end of the common bile duct and duodenal papilla, ampulla and other benign and malignant diseases. It is one of the most challenging operations in abdominal surgery. Although great progress has been made in the field of pancreatic surgery in recent years, the surgical technique has been improved and the nursing level has been improved, the mortality rate of this operation has been reduced to about 5%, however, the incidence of postoperative complications is still as high as 30%. Among them, pancreatic fistula is one of the most common and dangerous complications. The purpose of this study was to investigate the value of continuous Prolene line anastomosis of pancreatic duct and jejunum in pancreaticojejunostomy. Methods: the clinical data of 165 patients undergoing pancreaticoduodenectomy in the Department of Hepatobiliary surgery of the fourth Hospital of Hebei Medical University from June 2013 to June 2015 were retrospectively analyzed. Among them, 53 cases underwent consecutive pancreaticojejunal mucosal Prolene line anastomosis. 112 cases of common nested pancreaticojejunostomy were used. To compare the incidence of pancreatic fistula between the two groups. Statistical analysis was carried out with SPSS 21.0 software package. 蠂 2 test was used for statistical analysis. Results: of the 165 patients undergoing pancreaticoduodenectomy, 69 had postoperative complications (41.8%). The main complications were abdominal infection in 36 cases (21. 8%), pancreatic fistula in 19 cases, duodenal hemorrhage in 17 cases and pancreatic fistula in 19 cases. The incidence rate was 10.3% and 2 cases died during operation (mortality 1.2%). There were only 2 cases of pancreatic fistula in 53 patients who underwent continuous anastomosis of jejunal Prolene line, all of which were grade A. The pancreatic fistula disappeared and the incidence of pancreatic fistula was 3.810 / 53 after symptomatic treatment, and 112 cases were treated with common nested pancreaticojejunostomy. There were 17 cases of pancreatic fistula after operation, and the incidence of pancreatic fistula was 15.2R / 17 / 112%. There was a significant difference between the two groups (蠂 ~ (2) 4.493) (蠂 ~ (2) 4.493) (P ~ (0.037). Conclusion: the technique of continuous anastomosis of Prolene line of jejunal mucosa of pancreatic duct is to adopt continuous anastomosis of the main pancreatic duct and the whole layer of jejunum. The anastomosis is accurate, the pancreatic fistula is not easy to occur, the influence of pancreatic texture is small, and the Prolene needle and thread are integrated, the line body is smooth, and the friction force is small. Suitable for continuous anastomosis. This anastomosis method is convenient and feasible, and can significantly reduce the incidence of pancreatic fistula. It is a safe and feasible anastomosis method.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R656.64

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