本文選題：胰腸吻合術(shù) + 胰瘺　； 參考：《皖南醫(yī)學(xué)院》2016年碩士論文

【摘要】：目的:通過與胰腺空腸端側(cè)吻合的比較,探討貫穿式胰管空腸黏膜吻合的可行性及安全性。方法:采用家豬建立胰腸吻合的手術(shù)模型,將實驗豬隨機分為實驗組和對照組,實驗組8頭,對照組6頭,實驗組采用貫穿式胰管空腸黏膜吻合,對照組采用胰腺空腸端側(cè)吻合。術(shù)前測實驗豬體重,檢測空腹血糖、血清淀粉酶含量。術(shù)中觀察胰腺質(zhì)地、形狀、胰管直徑等情況,記錄術(shù)中吻合時間,并行吻合口測壓;術(shù)后三天測引流管中引流液的淀粉酶含量,觀察引流量及性質(zhì);術(shù)后注意觀察豬的精神狀態(tài),進食情況、排便時間及大便性狀等;術(shù)后一周再次手術(shù),觀察術(shù)中腹腔粘連情況,吻合口是否牢靠,周圍有無積液、積膿;取出吻合口,記錄手術(shù)時間,觀察大體及病理變化,對比研究貫穿式胰管空腸黏膜吻合的臨床應(yīng)用價值。結(jié)果:兩組吻合方式在術(shù)前體重、血糖、血清淀粉酶、胰管直徑、胰腺質(zhì)地、無統(tǒng)計學(xué)差異(P0.05),術(shù)中觀察胰腺質(zhì)地軟而脆,胰腺顯淡粉紅色,胰管直徑細(xì),胰管直徑實驗組為:1.15±0.21mm,對照組為1.16±0.18mm(t=0.155,P=0.879),P0.05,差異無統(tǒng)計學(xué)意義,具有可比性。兩組術(shù)中胰腸吻合時間:實驗組為15.13±3.44min,對照組為23.33±3.44min(t=4.415,P=0.001),P0.05,差異有統(tǒng)計學(xué)意義;術(shù)后實驗組一只家豬未醒死亡,尸檢探查吻合口周圍未見明顯滲液,考慮可能由于麻醉過量引起死亡;對照組一只家豬術(shù)后第三天死亡,尸檢可見腹腔大量積液,吻合口周圍有滲出,伴膿臭味,腹腔淀粉酶檢測值明顯升高,考慮術(shù)后胰瘺引起的感染性休克死亡。兩組術(shù)后胰瘺發(fā)生率:實驗組為0(0/7),對照組為33.33%(2/6),其中一例為B級胰瘺,一例為C級胰瘺;兩組家豬術(shù)后進食時間:實驗組為50.71±11.92h,對照組為83.4±12.23h(t=4.810,P=0.001),P0.05,差異有統(tǒng)計學(xué)意義;兩組七天后二次手術(shù)術(shù)中可見對照組腹腔黏連明顯較實驗組重,分離黏連耗時較長,尋找吻合口困難,第二次手術(shù)時間為:實驗組為97.6±16.37min,對照組為128.6±17.67min(t=3.135,P=0.011),P0.05,差異有統(tǒng)計學(xué)意義。實驗組吻合口大體形態(tài)完整,周圍無明顯滲出積液,空腸壁及胰腺無充血、水腫,吻合口愈合良好(見圖1)。對照組吻合口大體形態(tài)完整,周圍少量滲出積液,空腸壁充血、水腫,胰腺炎癥較重(見圖2)。吻合口病理實驗組可見胰腺及空腸壁形態(tài)完整,固定可靠,胰腺及空腸壁見可見少量炎癥細(xì)胞及多量成纖維細(xì)胞;對照組可見胰腺斷端與空腸壁連接疏松,胰腺殘端及空腸壁周圍充滿多量炎癥細(xì)胞,部分胰腺組織可見壞死。結(jié)論:貫穿式胰管空腸黏膜吻合是一種較為簡單、有效的胰腸吻合方式,值得臨床上推廣。
[Abstract]:Objective: to investigate the feasibility and safety of perforating jejunal mucosal anastomosis with pancreatic jejunal end-to-side anastomosis. Methods: a model of pancreaticojejunostomy was established in domestic pigs. The pigs were randomly divided into experimental group (n = 8) and control group (n = 6). The control group was treated with pancreatic jejunum end-to-side anastomosis. The body weight, fasting blood glucose and serum amylase were measured before operation. Pancreatic texture, shape, diameter of pancreatic duct were observed during operation, anastomosis time was recorded, anastomotic stoma pressure was measured, amylase content of drainage fluid in drainage tube was measured three days after operation, drainage flow rate and properties were observed. Pay attention to observe the mental state, feeding condition, defecation time and defecation character of the pig after operation, reoperate one week after operation, observe intraperitoneal adhesion during the operation, whether the anastomosis is firm or not, whether there is effusion around, accumulate pus, and take out the anastomotic stoma, The operative time, gross and pathological changes were recorded, and the clinical value of perforating jejunal mucosal anastomosis was compared. Results: there was no significant difference in preoperative body weight, blood glucose, serum amylase, pancreatic duct diameter, pancreatic texture between the two groups (P 0.05). During the operation, the pancreas was soft and brittle, the pancreas was light pink, and the diameter of pancreatic duct was fine. The diameter of pancreatic duct was 1.16 鹵0.18 鹵0.21 mm in the experimental group and 1.16 鹵0.18 mm in the control group. The difference was not statistically significant and comparable. The operative time of pancreaticojejunostomy was 15.13 鹵3.44 min in the experimental group and 23.33 鹵3.44 min in the control group (P 0.05). In the control group, a domestic pig died on the third day after operation. A large amount of fluid was found in the abdominal cavity at autopsy. There was exudation around the anastomotic stoma, and the amylase detection value in the abdominal cavity was obviously increased. The septic shock caused by pancreatic fistula after operation was taken into account in the death of septic shock. The incidence of postoperative pancreatic fistula was 0 / 7 in the experimental group and 33.33 / 2 / 6 in the control group, one of them was grade B pancreatic fistula and the other was grade C pancreatic fistula, the feeding time of the two groups was 50.71 鹵11.92 h in the experimental group and 83.4 鹵12.23 h in the control group (P 0.05). After the second operation seven days later in the two groups, the abdominal adhesion in the control group was significantly heavier than that in the experimental group, and the separation time was longer and the anastomotic site was difficult to find. The second operation time was 97.6 鹵16.37 min in the experimental group and 128.6 鹵17.67 min in the control group, and the difference was statistically significant. In the experimental group, the anastomotic stoma was generally intact, there was no effusion around it, no congestion and edema in the wall of the jejunum and pancreas, and the anastomotic site healed well (see figure 1). In the control group, the anastomotic stoma was generally intact, with a small amount of effusion, congestion, edema and severe pancreatitis (see Fig. 2). In the experimental group, the morphology of pancreas and jejunum wall was intact, the fixation was reliable, a small number of inflammatory cells and multiple fibroblasts were found in pancreas and jejunum wall, and in the control group, loose connection between the broken end of pancreas and the jejunum wall was observed. Pancreatic stump and jejunum wall were filled with inflammatory cells and necrosis was observed in some pancreatic tissues. Conclusion: perforated jejunostomy is a simple and effective pancreaticojejunostomy, which is worth popularizing in clinic.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R656

【參考文獻】

相關(guān)期刊論文 前10條

1 王小明;沈正超;胡明華;韓猛;王冠男;方小三;;貫穿式胰管空腸黏膜吻合在胰十二指腸切除術(shù)中的應(yīng)用[J];中國普通外科雜志;2015年09期

2 李云峰;陳梅福;梁路峰;廖春紅;李國光;劉劍鳴;;雙U套入荷包捆綁式胰腸吻合術(shù)預(yù)防術(shù)后胰瘺的動物實驗[J];中國普通外科雜志;2015年09期

3 張宇;楊洪吉;鄧小凡;朱世凱;陳云飛;陳凱;;袖套式prolene線單層連續(xù)縫合在胰腸吻合中的應(yīng)用[J];中國普通外科雜志;2015年03期

4 徐新建;呂驊;王喜艷;耿誠;晏冬;陳啟龍;溫浩;韋軍民;;胰腺組織學(xué)特點對胰腸吻合方式潛在風(fēng)險的分析[J];中國普通外科雜志;2014年09期

5 劉巍;花榮;陳煒;孫勇偉;吳志勇;;胰十二指腸切除術(shù)中胰腸吻合方式的選擇[J];中華普通外科雜志;2014年05期

6 朱學(xué)鋒;陳益君;余健;朱永勝;黃建軍;殷凱;曹亮亮;;家豬貫穿縫合式胰腸吻合實驗?zāi)Ｐ偷慕J];中華胰腺病雜志;2014年02期

7 多力坤·牙生;韓瑋;王喜艷;;胰腸吻合口瘺的危險因素臨床對照研究[J];醫(yī)學(xué)綜述;2014年06期

8 張新靜;張偉;張倜;崔云龍;李慧鍇;宋天強;李強;;Blumgart吻合在胰十二指腸切除術(shù)后胰腸吻合中的應(yīng)用[J];中華肝膽外科雜志;2013年11期

9 畢濤;李勇;王靜;馮玉杰;曲林林;孫傳東;;胰十二指腸切除術(shù)中兩種胰腸吻合方式療效比較[J];肝膽胰外科雜志;2013年06期

10 趙國剛;戴毅;徐建;石剛;徐威;田云鴻;;胰腺不同疾病術(shù)后胰瘺的危險因素分析[J];川北醫(yī)學(xué)院學(xué)報;2013年04期

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