本文選題：胰體尾切除術(shù) + 閉合器�。� 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]探討胰體尾切除術(shù)中關(guān)于胰腺殘端不同處理方式的優(yōu)劣,重點分析不同處理方式與術(shù)后胰瘺的關(guān)系,旨在探討胰腺殘端何種處理方式更為合理。[方法]回顧性分析2003年-2016年昆明醫(yī)科大學(xué)第一附屬醫(yī)院74例(包括外傷、結(jié)石及腫瘤等)行胰體尾切除術(shù)的患者臨床資料。1.首先分析患者胰腺質(zhì)地的軟硬、入院前是否伴有明顯臨床癥狀及術(shù)前是否伴有慢性胰腺炎對于胰瘺有何影響;2.再根據(jù)術(shù)中對其胰腺殘端不同的處理方式分為四組:(1)單純使用切割閉合器組17例(后文統(tǒng)稱為單純閉合器組);(2)單純手工縫合組19例(后文統(tǒng)稱為手工縫合組);(3)聯(lián)合使用單純閉合器及手工縫合組22例(后文統(tǒng)稱為聯(lián)合組);(4)胰腸吻合組16例。先對所有患者的入院主訴是否有明顯癥狀(如腹痛、惡心嘔吐、黃疸等)、術(shù)前是否伴發(fā)慢性胰腺炎及胰腺質(zhì)地與胰瘺的關(guān)系進行分析,再分別分析以下幾點的差異:(1)各組患者的一般情況(如性別比例、年齡、體質(zhì)指數(shù));(2)術(shù)后胰瘺率;(3)術(shù)中出血量;(4)手術(shù)時間;(5)術(shù)后住院時間;(6)住院總花費。[結(jié)果]1.術(shù)前一般情況與胰瘺的關(guān)系:(1)各組患者在性別比例、年齡、體質(zhì)指數(shù)方面均無明顯差異;(2)入院前主訴有明顯癥狀者術(shù)后胰瘺率34.37%,入院前無明顯癥狀者術(shù)后胰瘺率45.24%,P=0.474,二者差異無統(tǒng)計學(xué)意義;(3)胰腺質(zhì)地較軟者術(shù)后胰瘺率51.62%,質(zhì)地較硬者術(shù)后胰瘺率25.81%,P=0.033,二者差異有統(tǒng)計學(xué)意義;(4)術(shù)前伴發(fā)有慢性胰腺炎者術(shù)后胰瘺率24.13%,無慢性胰腺炎者術(shù)后胰瘺率51.11%,P=0.029,二者差異有統(tǒng)計學(xué)意義;2.胰腺殘端處理方式與胰瘺的關(guān)系:單純閉合器組、手工縫合組、聯(lián)合組和胰腸吻合組分別為:70.59%,31.57%,31.82%,31.25%,其中手工縫合組、聯(lián)合組及胰腸吻合組胰瘺率低于單純閉合器組,差異有統(tǒng)計學(xué)意義,而手工縫合組、聯(lián)合組及胰腸吻合組差異無統(tǒng)計學(xué)意義;3.在術(shù)中出血量方面四組分別為:150.18±24.49ml,153.94 ± 14.29ml,155.38±32.59ml,153.68±35.24ml,無明顯差異;4.在手術(shù)時間上胰腸吻合組(232.50±33.37min)高于手工縫合組(194.95±33.82min),手工縫合組又要高于聯(lián)合組(161.36±29.89min)與單純閉合器組(167.65±34.15min),聯(lián)合組與單純閉合器組則無明顯差異;5.在術(shù)后住院時間上四組分別:12.06±2.95d,12.05±3.15d,10.73±2.51d,14.69±3.03d,胰腸吻合組明顯高于其他三組,而其他三組無明顯差異;6.在住院總費用上手工縫合組最低(4.01 ±.088萬元),單純閉合器組(5.14±0.90萬元)與聯(lián)合組(4.66±0.68萬元)無明顯差異,而胰腸吻合組最高(5.69±0.87 萬元);[結(jié)論]1.四組患者在性別比例、年齡、體質(zhì)指數(shù)方面并無明顯差異,具有臨床可比性;入院前是否伴明顯癥狀與術(shù)后胰瘺并無明顯關(guān)系;胰腺質(zhì)地較軟者術(shù)后更易發(fā)生胰瘺;術(shù)前并發(fā)有慢性胰腺炎者術(shù)后不易發(fā)生胰瘺;2.不同處理方式對比分析:(1)在術(shù)后胰瘺方面,單純閉合器組手工縫合組=聯(lián)合組=胰腸吻合組,故不建議單純使用切割閉合器處理保留的胰腺殘端;(2)在術(shù)中出血量方面,四組并無明顯差異;(3)在手術(shù)時間上,胰腸吻合組手工縫合組聯(lián)合組=單純閉合器組。過長的手術(shù)時間有可能會增加術(shù)中相關(guān)并發(fā)癥發(fā)生的幾率;(4)在術(shù)后住院時間上胰腸吻合組明顯高于其他三組,而其他三組無明顯差異。過長的住院時間一方面會加大患者的心理壓力,另一方面也會產(chǎn)生更多的費用;(5)在住院總費用上,胰腸吻合組聯(lián)合組=單純閉合器組手工縫合組。綜上所述在實際操作過程中,臨床工作者應(yīng)綜合考慮患者患者實際情況決定使用何種方法。
[Abstract]:[Objective] to discuss the advantages and disadvantages of different treatment methods of pancreatic stump during the caudal pancreatectomy, and to analyze the relationship between different treatment methods and postoperative pancreatic fistula. The purpose of this study is to explore the way of treatment of pancreatic stump. [Methods] 74 cases (including trauma, calculi and tumor) in the First Affiliated Hospital of Kunming Medical University in 2003 were retrospectively analyzed. The clinical data of the patients with pancreatic caudectomy.1. first analyzed the soft and hard pancreatic texture of the patients, whether there were obvious clinical symptoms before admission and whether there was any effect of chronic pancreatitis on the pancreatic fistula before the operation. 2., four groups were divided according to the different treatment methods of the pancreatic stump during the operation: (1) 17 cases were simply used in the incision and closure group. The latter was referred to as the simple closure group; (2) 19 cases in the simple manual suture group (after the hand suture group); (3) the combined use of simple closure and manual suture group 22 cases (after the combined group); (4) 16 cases of pancreatic intestinal anastomosis group. First, the admission of all patients has obvious symptoms (such as abdominal pain, nausea nausea, jaundice, etc.), before operation is Analysis of the relationship between chronic pancreatitis and pancreatic texture and pancreatic fistula: (1) general conditions (such as sex ratio, age, body mass index); (2) postoperative pancreatic fistula rate; (3) intraoperative bleeding; (4) hand operation time; (5) postoperative hospitalization time; (6) general hospitalization expenses. [results]1. general conditions before operation) The relationship with pancreatic fistula: (1) there was no significant difference in sex ratio, age and body mass index in all groups; (2) the rate of pancreatic fistula after admission was 34.37%, the rate of pancreatic fistula was 45.24% after admission without obvious symptoms, and there was no significant difference between two and two. (3) the rate of pancreatic fistula after surgery was 51.62% and the quality of the pancreas was hard. The postoperative pancreatic fistula rate was 25.81%, P=0.033, and two differences were statistically significant; (4) the rate of pancreatic fistula with chronic pancreatitis was 24.13%, the rate of pancreatic fistula was 51.11%, P=0.029 without chronic pancreatitis, and the difference between the two were statistically significant; 2. the relationship between the pancreatic stump treatment and the pancreatic fistula: the simple closure group, the manual suture group, the combined group and the pancreas The intestinal anastomosis group were 70.59%, 31.57%, 31.82%, 31.25% respectively. The rate of pancreatic fistula in the group of manual suture group, the combined group and the pancreas enterostomy group was lower than that of the simple closure group, and the difference was statistically significant. The difference between the manual suture group, the combined group and the pancreas enterostomy group was not statistically significant. 3. the four groups in the intraoperative bleeding were 150.18 + 24.49ml, 153.94 + 14. .29ml, 155.38 + 32.59ml, 153.68 + 35.24ml, no significant difference. 4. in the operation time, the group of pancreatic and intestinal anastomosis (232.50 + 33.37min) was higher than that of the manual suture group (194.95 + 33.82min), and the manual suture group was higher than the combined group (161.36 + 29.89min) and the simple closure group (167.65 + 34.15min), and there was no significant difference between the combined group and the simple closure group; 5. in the operation. After hospitalization, the four groups were 12.06 + 2.95d, 12.05 + 3.15d, 10.73 + 2.51d, 14.69 + 3.03d, and the pancreatic intestinal anastomosis group was significantly higher than the other three groups, while the other three groups were not significantly different; 6. in the total hospitalization cost was the lowest (4.01 +.088 million yuan), and the simple closure group (5.14 + 9 thousand yuan) and the United Group (4.66 + 6 thousand and 800 yuan) had no significant difference. There was no significant difference in sex ratio, age and body mass index in group]1. four patients (5.69 + 8 thousand and 700 yuan). [Conclusion] there was no significant difference in sex ratio, age and body mass index. It was not easy to have pancreatic fistula; 2. the comparison and analysis of different treatment methods: (1) in the postoperative pancreatic fistula, the simple closure group hand suture group = combined group = Pancreaticoenterostomy group, so it is not recommended to simply use the cutting closure to treat the retained pancreatic stump; (2) there is no significant difference between the four groups in the amount of bleeding during the operation; (3) in the operation time, the Pancreaticoenterostomy group hand The combined group of the suture group = the simple closure group. The long operation time may increase the probability of the associated complications in the operation; (4) the group of pancreatic and intestinal anastomosis in the postoperative hospital time is obviously higher than the other three groups, while the other three groups have no significant difference. (5) in the total cost of hospitalization, the joint group of the group of Pancreaticoenterostomy = the manual suture group of the simple closure group. To sum up, in the actual operation, the clinical worker should consider what the patient's patient's actual situation decides to use.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R657.5

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