摘要
目的:探究"一针法"胰管对空肠黏膜端侧吻合在腹腔镜胰十二指肠切除术(LPD)中的临床效果。方法:选择邯郸市中心医院2016年5月—2018年11月行LPD治疗的102例患者作为研究对象,所有患者术中消化道重建时选择"一针法"胰管对空肠黏膜端侧吻合方式,分析手术情况及术后并发症的发生情况。结果:102例患者均顺利完成手术,平均手术时间为(411.4±72.1)min,平均胰肠吻合时间为(34.1±8.2)min,平均术中出血量为(346.9±312.4)mL,2例中转开放手术。术后病理学检查诊断80例恶性病变患者(占78.4%),以胰头导管腺癌、胆管下端癌为主,22例良性病变患者(21.6%),以胰腺实性假乳头状瘤、胰腺导管内乳头状黏液瘤为主。94例患者行淋巴结清除,平均清除数为(11.1±1.7)个;13例发生淋巴结转移,完整切除占93.8%(75/80)。术后共29例(28.4%)患者发生并发症,其中7例术后出血(6.9%);17例(16.7%)患者出现胰瘘,B级胰瘘6例(5.9%),经引流、抗生素治疗均痊愈,C级胰瘘1例(1.0%),经再次手术逐渐好转;3例(2.9%)肺部感染;2例(2.0%)胃排空障碍。围手术期死亡4例。结论:"一针法"胰管对空肠黏膜端侧吻合在LPD消化道重建时安全有效,可减少术后胰瘘等并发症的发生,缩短吻合时间,值得进一步研究和推广应用。
Objective:To explore the clinical effect of pancreatoduodenectomy in laparoscopic using Single-stitch pancreatic duct suture.Method:102 patients treated with LPD in Handan Central Hospital from May 2016 to November 2018 were selected as research objects.Single-stitch pancreatic duct suture was selected in the reconstruction of pancreatodigestive tract.After that,the operation and postoperative complications were analyzed.Results:The average operative time was(411.4±72.1)min,the average pancreaticointestinal anastomosis was(34.1±8.2)min,and the average intraoperative blood loss was(346.9±312.4)mL;Postoperative pathological examination diagnosed 80 patients with malignant lesions(78.4%),mainly with pancreatic head ductal adenocarcinoma and carcinoma of the lower bile duct,and 22 patients with benign lesions(21.6%),mainly with solid pseudopapillary papilloma of pancreas and intraductal papillary myxoma of pancreas;The average number of lymph node dissection was(11.1±1.7)in 94 patients,and lymph node metastasis occurred in 13 patients,with complete resection accounting for 93.8%(75/80);Postoperative complications,a total of 29 patients(28.4%),7 cases of postoperative bleeding(6.9%),17 cases of patients with pancreatic fistula(16.7%),grade B pancreatic leakage and 6 cases(5.9%),the drainage and antibiotic therapy were recovered,grade C pancreatic fistula in 1 case(1.0%),after reoperation gradually improved,3 cases of pulmonary infection(2.9%),2 cases of gastric emptying disorder(2.0%),4 cases of perioperative death.Conclusion:Single-stitch pancreatic duct suture is safe and effective in pancreatic and digestive tract reconstruction,and it can reduce the incidence of postoperative complications such as pancreatic leakage and shorten the anastomosis time.
作者
尹立阳
郭书华
石媛媛
袁增江
YIN Li-yang;GUO Shu-hua;SHI Yuan-yuan;YUAN Zeng-jiang(Department of General Surgery,Handan Central Hospital,Handan 056001,China)
出处
《中国现代普通外科进展》
CAS
2020年第7期534-537,共4页
Chinese Journal of Current Advances in General Surgery
基金
2019年度河北省医学科学研究课题计划(20190199)。
关键词
一针法
腹腔镜
胰十二指肠切除术
消化道重建
胰肠吻合
Single-stitch pancreatic duct suture
Laparoscope
Pancreatoduodenectomy
Digestive tract reconstruction
The pancreatic anastomosis
