【摘要】：目的：通過分析胰十二指腸切除術(PD)中不同的胰腺-空腸吻合方式對術后胰腸吻合口瘺的發(fā)生率,探究合理的胰腸吻合方式對預防PD術后胰腸吻合口瘺的重要性。方法：回顧性分析2009年1月到2014年1月在蘭州大學第一醫(yī)院普通外科施行胰十二指腸切除術115例患者的基本資料,根據(jù)胰腺-空腸吻合方式將患者分為3組：套入吻合組(A組)45例,行套入式胰腺-空腸吻合；黏膜吻合組(B組)54例,行胰管-空腸黏膜端側(cè)吻合；漿肌層吻合組(C組)16例,行胰腺-空腸漿肌層吻合,比較3組患者術后的胰腸吻合口瘺發(fā)生率。應用統(tǒng)計學軟件SPSS 21統(tǒng)計學分析,對圍手術期出現(xiàn)胰腸吻合口瘺的相關性因素進行分析。結(jié)果：115例患者PD術后出現(xiàn)胰腸吻合口瘺20例,胰腸吻合口瘺總的發(fā)生率是17.4%(20/115),其中套入吻合組10例,占22.2%(10/45)；黏膜吻合組4例,占7.4%(4/54)；漿肌層吻合組6例,占37.5%(6/16)。3組患者的胰腸吻合口瘺發(fā)生率不全相同(χ2=8.891,P=0.011)。胰腸吻合口瘺發(fā)生率在胰腺空腸套入吻合組與胰管-空腸黏膜吻合組間差異顯著(P=0.049,95%可信區(qū)間0.00-0.30),胰管-空腸黏膜吻合組與胰腺-空腸漿肌層吻合組間差異同樣顯著(P=0.005,95%可信區(qū)間-0.51～-0.09),胰腺-空腸套入吻合組與胰腺-空腸漿肌層吻合組間差異無統(tǒng)計學意義(P=0.157,95%可信區(qū)間-0.37--0.06)。單因素分析結(jié)果顯示性別、年齡、術前營養(yǎng)狀況、黃疸程度、是否有糖尿病、胰管直徑、胰腺質(zhì)地、疾病類型等對PD術后胰腸吻合口瘺的關系不密切(P0.05),胰腺-空腸吻合方法是胰十二指腸切除術后胰腸吻合口瘺的獨立危險因素。結(jié)論：良好的胰腺-空腸吻合技術是防止PD術后胰腸吻合口瘺發(fā)生的重要保障,胰管-空腸黏膜吻合操作簡便,胰腸吻合口瘺發(fā)生率低,建議采用。
[Abstract]:Objective: to explore the importance of reasonable pancreaticojejunostomy in preventing pancreaticojejunostomy fistula after pancreaticoduodenectomy by analyzing the incidence of pancreaticojejunostomy in (PD). Methods: from January 2009 to January 2014, 115 patients underwent pancreatoduodenectomy in the first Hospital of Lanzhou University were analyzed retrospectively. Patients were divided into three groups according to pancreato-jejunostomy: group A (45 cases), group B (54 cases), group C (16 cases). The incidence of pancreaticojejunostomy fistula in 3 groups was compared. The correlation factors of pancreaticojejunostomal fistula in perioperative period were analyzed by SPSS 21 software. Results the total incidence of pancreaticojejunostomy fistula was 17.4% (20 / 115) in 115 cases of PD, including 10 cases (22. 2%) in the anastomosis group, 4 cases (7. 4%) in the mucosal anastomosis group, 6 cases in the sarcoplasmic myostomy group, 4 cases in the mucosal anastomosis group, and 6 cases in the sarcoplasmic myostomy group. The incidence of pancreaticojejunostomal fistula in 37.5% (6 / 16) group was not the same (蠂 ~ (2 +) 8.891g / P ~ (0.011). The incidence of pancreaticojejunostomy fistula was significantly different between the pancreatic jejunostomy group and the pancreatic duct jejunal mucosa anastomosis group (P 0.049 95% confidence interval 0.00-0.30). The difference was also significant between the pancreatic duct and jejunal mucosa anastomosis group and the pancreatic jejunal muscular layer anastomosis group. There was no significant difference between the pancreatic jejunostomy group and the pancreaticojejunal muscular layer anastomosis group (P < 0.157 ~ 95% confidence interval -0.37 ~ 0.06). Univariate analysis showed that sex, age, preoperative nutritional status, degree of jaundice, diabetes, pancreatic duct diameter, pancreatic texture, The type of disease was not closely related to pancreaticojejunostomy fistula after PD (P0.05). Pancreaticojejunostomy was an independent risk factor for pancreaticojejunostomy fistula after pancreaticoduodenectomy. Conclusion: good technique of pancreaticojejunostomy is an important guarantee to prevent pancreaticojejunostomy fistula after PD. The operation of pancreaticojejunostomy is simple and the incidence of pancreaticojejunostomy fistula is low.
【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R656

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