不同吻合手术对胰十二指肠切除术后并发症发生率的影响
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摘要
目的 :探讨不同吻合手术对胰十二指肠切除术(PD)后并发症发生率的影响。方法 :回顾性分析经胰管空肠黏膜-黏膜吻合(A组,n=38)、套入式胰肠端端吻合(B组,n=32)及胰腺空肠捆绑式吻合(C组,n=30)方案行PD治疗的100例患者临床资料。比较其术后相关并发症发生率及胰瘘严重程度差异,记录其术后1年时胰腺外分泌功能指标[粪弹性蛋白酶(FE)]、内分泌功能指标[胰高血糖素(GLC)、生长抑素(SS)]、营养状况指标[体重指数(BMI)、血清白蛋白、前白蛋白]及生活质量[癌症患者生命质量测定量表(FACT-G)]评估结果差异。结果 :三组患者均无围术期死亡病例;术后并发症发生率显示:C组 Objective To investigate the effect of different anastomotic surgeries on the incidence of complications after pancreaticoduodenectomy(PD). Methods The clinical data of 100 patients treated with PD by pancreatic duct jejunal mucosa anastomosis(group A, n=38), encasing pancreatic and intestinal anastomosis(group B, n=32) and pancreatic jejunal bundle anastomosis(group C, n=30) were retrospectively analyzed. The incidence of postoperative complications and the severity of pancreatic fistula were compared. The pancreatic exocrine function indexes at 1 year after surgery [fecal elastase(FE) ], endocrine function indexes [glucagon(GLC), somatostatin(SS) ], nutritional status indexes [body mass index(BMI), serum albumin, prealbumin] and the quality of life score [Functional Assessment of Cancer Therapy-General(FACT-G) ] were recorded. Results There was no perioperative death in the three groups. The incidence of postoperative complications showed group C < group A < group B. The incidence of pancreatic fistula and grade C rate were significantly lower in group C than the other two groups, but there was no significant difference between group A and group B.1 year after surgery, there were no significant differences among the three groups in pancreatic exocrine function indexes, pancreatic endocrine function indexes and nutritional status. The FACT-G score showed group C > group A > group B. Conclusion The three anastomotic surgeries are of certain application value in PD, and pancreatic jejunal bundle anastomosis can effectively reduce the risk of postoperative complications, which is good for improving the quality of life of patients.
引文
[1]马炳奇,张顺,张斌,等.胰十二指肠切除术后胰瘘发生的相关性因素分析[J].中国普通外科杂志,2013,22(3):315-319.
[2]陈正民,黄强,刘臣海,等.胰十二指肠切除术后胰瘘的危险因素分析[J].重庆医学,2015,44(29):4156-4158.
[3]潘超,席鹏程,侍作亮,等.Blumgart吻合在胰十二指肠切除术后胰瘘防治中的作用[J].临床肝胆病杂志,2016,32(2):333-336.
[4]华小斌,付强,佘明杰,等.胰腺-空肠套入式吻合与胰管-空肠黏膜吻合对胰十二指肠切除术术后并发症发生情况的影响[J].安徽医学,2016,37(4):405-409.
[5]洪德飞.胰十二指肠切除术[M].北京:人民卫生出版社,2014:183-185.
[6]Bassi C,Dervenis C,Butturini G,et al.Postoperative pancreatic fistula:an international study group(ISGPF)definition[J].Surgery,2005,138(1):8-13.
[7]中华胰腺病杂志编委会,中华医学会消化内镜学分会.慢性胰腺炎诊治指南(2012,上海)[J].中华消化内镜杂志,2012,29(6):301-303.
[8]万崇华,孟琼,汤学良,等.癌症患者生命质量测定量表FACT-G中文版评介[J].实用肿瘤杂志,2006,21(1):77-80.
[9]殷晓煜,蔡建鹏,陈伟,等.老年患者胰十二指肠切除术后并发症及其危险因素分析[J].中华解剖与临床杂志,2014,19(2):129-134.
[10]黄佳飞,张倜,周洪渊,等.胰肠吻合方式对胰十二指肠切除术后胰瘘的影响[J].中国肿瘤临床,2015,42(8):441-445.
[11]欧阳柳,金钢.如何减少胰十二指肠切除术后胰瘘的发生[J].肝胆外科杂志,2015,23(2):85-86.
[12]何勇,张辉,王正峰,等.两种减压管放置方法对胰十二指肠切除术后胰瘘的影响分析[J].中国普通外科杂志,2016,25(3):407-412.
[13]陈一帆,刘巍,花荣,等.根据胰管直径等因素选择不同胰肠吻合方式对患者术后恢复的影响[J].肝胆胰外科杂志,2014,26(3):181-184.
[14]毛由军,陈钟,贾玉清,等.胰十二指肠切除术中不同胰肠吻合方式和胰管引流方式对胰瘘的影响[J].实用临床医药杂志,2015,19(7):111-113.
[15]陶杰,耿智敏,王林,等.全胰十二指肠切除术的安全性与疗效分析[J].西部医学,2015,27(7):1011-1012,1015.
[16]吴琼,卢秀兰,祝益民,等.重症患儿粪弹性蛋白酶-1的变化及其临床意义[J].中华急诊医学杂志,2015,24(5):536-540.
[17]刘续宝,熊俊杰.从远期生活质量再议胰肠吻合与胰胃吻合合理选择[J].中国实用外科杂志,2016,36,36(8):839-843.
[18]苏松,徐茂锦,李兆申,等.胰源性糖尿病最新研究进展[J].中华胰腺病杂志,2016,16(3):214-216.
[19]Cherif R,Gaujoux S,Cros J,et al.Parenchyma-sparing pancreatectomies for pancreatic neuroendocrine tumors[J].International Journal of Endocrine Oncology,2015,2(3):150901081543001.
[20]宋璐璐,杨文英.胰源性糖尿病的研究进展[J].中华糖尿病杂志,2013,5(4):238-241.
[2]陈正民,黄强,刘臣海,等.胰十二指肠切除术后胰瘘的危险因素分析[J].重庆医学,2015,44(29):4156-4158.
[3]潘超,席鹏程,侍作亮,等.Blumgart吻合在胰十二指肠切除术后胰瘘防治中的作用[J].临床肝胆病杂志,2016,32(2):333-336.
[4]华小斌,付强,佘明杰,等.胰腺-空肠套入式吻合与胰管-空肠黏膜吻合对胰十二指肠切除术术后并发症发生情况的影响[J].安徽医学,2016,37(4):405-409.
[5]洪德飞.胰十二指肠切除术[M].北京:人民卫生出版社,2014:183-185.
[6]Bassi C,Dervenis C,Butturini G,et al.Postoperative pancreatic fistula:an international study group(ISGPF)definition[J].Surgery,2005,138(1):8-13.
[7]中华胰腺病杂志编委会,中华医学会消化内镜学分会.慢性胰腺炎诊治指南(2012,上海)[J].中华消化内镜杂志,2012,29(6):301-303.
[8]万崇华,孟琼,汤学良,等.癌症患者生命质量测定量表FACT-G中文版评介[J].实用肿瘤杂志,2006,21(1):77-80.
[9]殷晓煜,蔡建鹏,陈伟,等.老年患者胰十二指肠切除术后并发症及其危险因素分析[J].中华解剖与临床杂志,2014,19(2):129-134.
[10]黄佳飞,张倜,周洪渊,等.胰肠吻合方式对胰十二指肠切除术后胰瘘的影响[J].中国肿瘤临床,2015,42(8):441-445.
[11]欧阳柳,金钢.如何减少胰十二指肠切除术后胰瘘的发生[J].肝胆外科杂志,2015,23(2):85-86.
[12]何勇,张辉,王正峰,等.两种减压管放置方法对胰十二指肠切除术后胰瘘的影响分析[J].中国普通外科杂志,2016,25(3):407-412.
[13]陈一帆,刘巍,花荣,等.根据胰管直径等因素选择不同胰肠吻合方式对患者术后恢复的影响[J].肝胆胰外科杂志,2014,26(3):181-184.
[14]毛由军,陈钟,贾玉清,等.胰十二指肠切除术中不同胰肠吻合方式和胰管引流方式对胰瘘的影响[J].实用临床医药杂志,2015,19(7):111-113.
[15]陶杰,耿智敏,王林,等.全胰十二指肠切除术的安全性与疗效分析[J].西部医学,2015,27(7):1011-1012,1015.
[16]吴琼,卢秀兰,祝益民,等.重症患儿粪弹性蛋白酶-1的变化及其临床意义[J].中华急诊医学杂志,2015,24(5):536-540.
[17]刘续宝,熊俊杰.从远期生活质量再议胰肠吻合与胰胃吻合合理选择[J].中国实用外科杂志,2016,36,36(8):839-843.
[18]苏松,徐茂锦,李兆申,等.胰源性糖尿病最新研究进展[J].中华胰腺病杂志,2016,16(3):214-216.
[19]Cherif R,Gaujoux S,Cros J,et al.Parenchyma-sparing pancreatectomies for pancreatic neuroendocrine tumors[J].International Journal of Endocrine Oncology,2015,2(3):150901081543001.
[20]宋璐璐,杨文英.胰源性糖尿病的研究进展[J].中华糖尿病杂志,2013,5(4):238-241.