【摘要】：目的:探討U型套入式端側(cè)胰腸吻合技術(shù)在胰十二指腸切除術(shù)中應(yīng)用的安全性和實(shí)用性。方法:回顧性分析2008年09月至2016年09月于延邊大學(xué)附屬醫(yī)院行胰十二指腸切除術(shù)的163例患者的臨床資料,根據(jù)胰腸吻合方式的不同分為三組:胰管空腸黏膜對(duì)黏膜吻合組(A組)28例、空腸腔內(nèi)無(wú)胰斷端裸露的胰腸吻合組(B組)90例和U型套入式端側(cè)胰腸吻合組(C組)45例(包括1例腹腔鏡下胰腸吻合)。比較分析三組胰瘺相關(guān)的危險(xiǎn)因素、主要并發(fā)癥的發(fā)生率、吻合時(shí)間及術(shù)后住院時(shí)間差異。結(jié)果:三組間胰瘺相關(guān)危險(xiǎn)因素比較無(wú)統(tǒng)計(jì)學(xué)差異。三組間胰瘺發(fā)生率比較差異有統(tǒng)計(jì)學(xué)意義(A組:32.1%,B組3.3%,C組2.2%,P0.001);臨床胰瘺(B+C級(jí))三組間比較有統(tǒng)計(jì)學(xué)差異(A組:17.9%,B組:2.2%,C組:0%,P0.001):與B組相比,A組高于B組,差異有統(tǒng)計(jì)學(xué)意義(P=0.0080.0167);A組與C組相比,差異有統(tǒng)計(jì)學(xué)意義(P=0.0070.0167),C組低于A組;而B組和C組則差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.5520.0167)。其它非胰瘺主要并發(fā)癥(胃排空延遲、膽瘺等)三組間比較無(wú)統(tǒng)計(jì)學(xué)差異.(P0.05)。比較三組胰腸吻合時(shí)間,差異具有顯著的統(tǒng)計(jì)學(xué)意義(A組29.1±2.6 min,B組25.1±2.6 min,C組13.6±2.4 min,P＜0.001):A組吻合時(shí)間高于B組和C組(P0.001,),B組吻合時(shí)間高于C組(P0.001);三組間術(shù)后住院時(shí)間差異未見(jiàn)統(tǒng)計(jì)學(xué)意義。結(jié)論:U型套入式端側(cè)胰腸吻合技術(shù)安全實(shí)用,可有效降低術(shù)后臨床胰瘺發(fā)生率;吻合時(shí)間短,操作簡(jiǎn)單,易于掌握;可適用于腹腔鏡下胰十二指腸切除術(shù)時(shí)的胰腸吻合。
[Abstract]:Objective: to evaluate the safety and practicability of U-type inserted end-to-side pancreaticojejunostomy in pancreaticoduodenectomy. Methods: the clinical data of 163 patients undergoing pancreaticoduodenectomy in the affiliated Hospital of Yanbian University from September 2008 to September 2016 were retrospectively analyzed. According to the different ways of pancreaticojejunostomy, they were divided into three groups: pancreatic duct-jejunum mucosa-to-mucosa anastomosis group (group A), 28 cases. There were 90 cases in group B (n = 90) and 45 cases (group C) in group C (including 1 case under laparoscopic pancreaticojejunostomy) without denudation of pancreaticojejunostomy without pancreaticojejunostomy (group B) and U-type nested end-to-side pancreatojejunostomy (group C). The risk factors related to pancreatic fistula, the incidence of major complications, the duration of anastomosis and postoperative hospital stay were compared and analyzed among the three groups. Results: there was no significant difference in the risk factors of pancreatic fistula among the three groups. There was a significant difference in the incidence of pancreatic fistula among the three groups (group A: 32.1%, group B 3.3%, group C 2.2%, P0.001). There were statistical differences among three groups (group A: 17.9%, group B: 2.2%, group C: 0%, P0.001): compared with group B, group A was significantly higher than group B (P < 0.001). There was a significant difference between group A and group C (P < 0. 0070.0167), C), but there was no significant difference between group B and group C (P < 0. 5520.0167). Other major complications of non-pancreatic fistula (delayed gastric emptying, biliary fistula, etc.) there was no significant difference among the three groups (P0.05). There was a significant difference in the time of pancreaticointestinal anastomosis among the three groups (29.1 鹵2.6min,P, 25.1 鹵2.6min,P, 13.6 鹵2.4min,P < 0.001): A, group A: 29.1 鹵2.6min,P < 0.001): A, P 0.001, P < 0.001, P < 0.01, P < 0.05). The anastomosis time in), B group was longer than that in C group (P0.001). There was no significant difference in postoperative hospitalization time among the three groups. Conclusion: the technique of U-type inserted end-to-side pancreaticojejunostomy is safe and practical, can effectively reduce the incidence of postoperative pancreatic fistula, the anastomosis time is short, the operation is simple and easy to master, and it can be applied to pancreaticojejunostomy during laparoscopic pancreaticoduodenectomy.
【學(xué)位授予單位】：延邊大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R656

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