摘要
目的探讨胰肠吻合口大网膜包裹技术对于降低胰十二指肠切除术(PD)后胰瘘发生率的效果。方法回顾性分析2009年1月至2015年10月第二军医大学东方肝胆外科医院胆道二科单一手术组实施的225例胰十二指肠切除术的病例资料。根据术中是否实施胰肠吻合口网膜包裹技术分为包裹组(125例)和未包裹组(100例),经倾向性评分匹配(PSM)后,比较包裹组(64例)和未包裹组(64例)胰瘘的发生率。结果手术均顺利完成,225例病人总并发症发生率为62.7%(141/225),再手术率2.7%(6/225),病死率2.7%(6/225)。胰瘘发生率为46.7%(105/225),包括A级61例、B级37例、C级7例,出血发生率为11.%(25/225),胃排空障碍(DGE)发生率为24.9%(56/225),腹腔感染发生率为20.9%(47/225)。除术后胰瘘发生率外,两组病人出血、DGE、腹腔感染发生率差异均无统计学意义(P>0.05)。包裹组无再次手术病人,死亡2例;未包裹组再次手术4例,死亡4例;两组间比较差异均无统计学意义(P=0.119、0.680)。在PSM模型中,单因素分析显示,胰腺质地、胰管直径及网膜包裹与术后胰瘘发生相关;多因素分析显示,胰管直径<3 mm及未行网膜包裹是胰瘘发生的独立危险因素。结论 PD中采用胰肠吻合口网膜包裹技术可降低术后胰瘘的发生率。
Objective To investigate the efficacy of the omentum wrapping technique in pancreaticojejunostomy on decreasing the incidence of pancreatic fistula after pancreaticoduodenectomy. Methods The clinical data of 225 patients underwent pancreaticoduodenectomy and pancreaticojejunostomy in single operation group from January 2009 to October 2015 in No.2 Department of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital Affiliated to the Second Military Medical University were analyzed retrospectively. Patients were divided into two groups, including group with omentum wrapping technique （n=125） and control group without it （n=100）. After propensity score matching, the rates of pancreatic fistula were compared between the two groups, including group with omentum wrapping technique （n= 64） and control group without it （n=64）. Results All operations were completed successfully. The overall complication rate of all 225 patients was 62.7%（141/225）. The reoperation rate was 2.7%（6/225）. The mortality is 2.7% （6/225）. The incidence of pancreatic fistula was 46.7% （ 105/225）, including 61 cases of Class A, 37 cases of Class B, and 7 cases of Class C. The incidence of bleeding was 11% （25/225）. The incidence of DGE was 24.9% （56/225）. The incidence of abdominal infection was 20.9% （47/225）. Except the incidence of pancreatic fistula, there was no statistical difference between the two groups in the incidence of bleeding, DGE and abdominal infection （P〉0.05）. In the omentum wrapping group, no reoperation case occurred, and there were only 2 death cases. In the control group, there were 4 reoperation cases and 4 death cases. There was no significant difference between the two groups in those data （P=0.119, 0.680）. In the PSM model, soft pancreas, pancreatic duct diameter and omentum wrapping were related to the postoperative pancreatic fistula in single factor analysis. In the multiple factors analysis, pancreatic duct diameter 〈3 mm and no omentum wrapping were independent risk factors for pancreatic fistula. Conclusion The omentum wrapping technique can decrease the rate of pancreatic fistula and it is worth applying in pancreaticojejunostomy.
出处
《中国实用外科杂志》
CSCD
北大核心
2016年第11期1200-1204,共5页
Chinese Journal of Practical Surgery
关键词
网膜包裹
胰十二指肠切除术
胰肠吻合
胰瘘
omentum wrapping
pancreati-coduodenectomy
pancreaticojejunostomy
pancreatic fistula
作者简介
通信作者：张永杰，E-mail：yjoy005@sina．com
