不同胰-空肠吻合方式对胰十二指肠切除术后胰瘘发生的影响_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 马立斌 ^1,2 , 柴琛 ¹ ,  曹农 ¹

1. ;
2. ;

Corresponding author：

曹农, Email: 455817277@qq.com

Keywords：

胰-肠吻合; 胰瘘; 胰十二指肠切除术; 防治

DOI：

10.7507/1007-9424.20150188

Video：

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目的比较胰十二指肠切除术中不同胰-空肠吻合方式对术后胰瘘发生率的影响。方法回顾性分析兰州大学第一医院普外科2009年1月至2014年1月期间施行胰十二指肠切除术的115例患者的临床资料，根据胰-空肠吻合方式将患者分为3组：套入吻合组45例，行胰-空肠套入式吻合；黏膜吻合组54例，行胰管-空肠黏膜吻合；浆肌层吻合组16例，行胰管-空肠浆肌层吻合，比较3组患者术后的胰瘘发生率。结果 115例患者术后发生胰瘘20例，胰瘘发生率为17.4%（20/115），其中套入吻合组10例，占22.2%（10/45）；黏膜吻合组4例，占7.4%（4/54）；浆肌层吻合组6例，占37.5%（6/16）。3组患者的胰瘘发生率比较不同或不全相同（P=0.011），其中套入吻合组和浆肌层吻合组的胰瘘发生率均高于黏膜吻合组（P＜0.017），而前2组间胰瘘发生率的差异无统计学意义（P＞0.017）。结论良好的吻合技术是预防胰瘘发生的重要保障，胰管-空肠黏膜吻合的操作简便，胰瘘发生率低，建议采用。

Citation： 马立斌, 柴琛, 曹农. 不同胰-空肠吻合方式对胰十二指肠切除术后胰瘘发生的影响. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(6): 729-731. doi: 10.7507/1007-9424.20150188 Copy

1.	Reid-Lombardo KM, Farnell MB, Crippa S, et al. Pancreatic anastomotic leakage after pancreaticoduodenectomy in 1 507 patients:a report from the Pancreatic Anastomotic Leak Study Group. J Gastrointest Surg, 2007, 11(11):1451-1459.
2.	徐泽宽, 郭峰, 苗毅, 等. 502例胰十二指肠切除术后主要并发症的临床分析.中华肝胆外科杂志, 2009, 15(11):809-812.
3.	Suc B, Msika S, Fingerhut A, et al. Temporary fibrin glue occlusion of the main pancreatic duct in the prevention of intra-abdominal complications after pancreatic resection:prospective randomized trial. Ann Surg, 2003, 237(1):57-65.
4.	Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula:an international study group (ISGPF) definition. Surgery, 2005, 138(1):8-13.
5.	中华医学会外科学分会外科手术学学组.胰腺外科手术中胰腺断端吻合缝合技术及材料选择专家共识(2008).中国实用外科杂志, 2008, 28(10):807-809.
6.	Figueras J, Sabater L, Planellas P, et al. Randomized clinical trial of pancreaticogastrostomy versus pancreaticojejunostomy on the rate and severity of pancreatic fistula after pancreaticoduodenectomy. Br J Surg, 2013, 100(12):1597-1605.
7.	Mckay A, Mackenzie S, Sutherland FR, et al. Meta-analysis of pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy. Br J Surg, 2006, 93(8):929-936.
8.	Grace PA, Pitt HA, Tompkins PK, et al. Decreased morbidity and mortality after pancreatoduodenectomy. Am J Surg, 1986, 151(1):141-149.
9.	Hosotani R, Doi R, Imamura M. Duct-to-mucosa pancreaticojejunostomy reduces the risk of pancreatic leakage after pancreatoduodenectomy. World J Surg, 2002, 26(1):99-104.
10.	张永, 苏丽湘.胰十二指肠切除术后不同胰肠吻合方式的效果与评价.现代诊断与治疗, 2013, 24(4):823-824.
11.	Tani M, Onishi H, Kinoshita H, et al. The evaluation of duct-tomucosal pancreaticojejunostomy in pancreaticoduodenectomy. World J Surg, 2005, 29(1):76-79.
12.	Grobmyer SR, Pieracci FM, Allen PJ, et al. Defining morbidity after pancreaticoduodenectomy:use of a prospective complication grading system. J Am Coll Surg, 2007, 204(3):356-364.
13.	Wojcicki M, Post M, Jarosz K, et al. Pancreatoduodenectomy with a modified duct-to-mucosa pancreaticojejunostomy:an analysis of 101 consecutive patients. Hepatogastroenterology, 2012, 59(117):1626-1630.
14.	Oida T, Mimastu K, Kawasaki A, et al. Toward zero pancreatic leakage after pancreaticoduodenectomy for soft pancreas in lowvolume pancreatic surgery centers. Hepatogastroenterology, 2009, 56(91-92):886-890.

1. Reid-Lombardo KM, Farnell MB, Crippa S, et al. Pancreatic anastomotic leakage after pancreaticoduodenectomy in 1 507 patients:a report from the Pancreatic Anastomotic Leak Study Group. J Gastrointest Surg, 2007, 11(11):1451-1459.
2. 徐泽宽, 郭峰, 苗毅, 等. 502例胰十二指肠切除术后主要并发症的临床分析.中华肝胆外科杂志, 2009, 15(11):809-812.
3. Suc B, Msika S, Fingerhut A, et al. Temporary fibrin glue occlusion of the main pancreatic duct in the prevention of intra-abdominal complications after pancreatic resection:prospective randomized trial. Ann Surg, 2003, 237(1):57-65.
4. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula:an international study group (ISGPF) definition. Surgery, 2005, 138(1):8-13.
5. 中华医学会外科学分会外科手术学学组.胰腺外科手术中胰腺断端吻合缝合技术及材料选择专家共识(2008).中国实用外科杂志, 2008, 28(10):807-809.
6. Figueras J, Sabater L, Planellas P, et al. Randomized clinical trial of pancreaticogastrostomy versus pancreaticojejunostomy on the rate and severity of pancreatic fistula after pancreaticoduodenectomy. Br J Surg, 2013, 100(12):1597-1605.
7. Mckay A, Mackenzie S, Sutherland FR, et al. Meta-analysis of pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy. Br J Surg, 2006, 93(8):929-936.
8. Grace PA, Pitt HA, Tompkins PK, et al. Decreased morbidity and mortality after pancreatoduodenectomy. Am J Surg, 1986, 151(1):141-149.
9. Hosotani R, Doi R, Imamura M. Duct-to-mucosa pancreaticojejunostomy reduces the risk of pancreatic leakage after pancreatoduodenectomy. World J Surg, 2002, 26(1):99-104.
10. 张永, 苏丽湘.胰十二指肠切除术后不同胰肠吻合方式的效果与评价.现代诊断与治疗, 2013, 24(4):823-824.
11. Tani M, Onishi H, Kinoshita H, et al. The evaluation of duct-tomucosal pancreaticojejunostomy in pancreaticoduodenectomy. World J Surg, 2005, 29(1):76-79.
12. Grobmyer SR, Pieracci FM, Allen PJ, et al. Defining morbidity after pancreaticoduodenectomy:use of a prospective complication grading system. J Am Coll Surg, 2007, 204(3):356-364.
13. Wojcicki M, Post M, Jarosz K, et al. Pancreatoduodenectomy with a modified duct-to-mucosa pancreaticojejunostomy:an analysis of 101 consecutive patients. Hepatogastroenterology, 2012, 59(117):1626-1630.
14. Oida T, Mimastu K, Kawasaki A, et al. Toward zero pancreatic leakage after pancreaticoduodenectomy for soft pancreas in lowvolume pancreatic surgery centers. Hepatogastroenterology, 2009, 56(91-92):886-890.

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不同胰-空肠吻合方式对胰十二指肠切除术后胰瘘发生的影响

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