胰十二指肠切除术中连续胰肠吻合和Y形空肠内引流的应用.DOCVIP

临床医学论文-胰十二指肠切除术中连续胰肠吻合和Y形空肠内引流的应用 ??????????? 作者：遆振宇，岳树强，赵威，王琳，陶开山，窦科峰? 【摘要】? 目的 评价连续胰肠吻合和Y形空肠内引流在胰十二指肠切除术中的应用，并与传统的胰十二指肠切除术进行比较。 方法 本组回顾2004年12月至2006年12月间行胰十二指肠切除患者103例，其中接受连续胰肠吻合和Y形空肠内引流的患者55例作为观察组，传统胰十二指肠切除术后捆绑式胰肠吻合的患者48例作为对照组。对两组的手术时间、术中出血量、术后胰漏、术后并发症和术后住院时间以及住院费用等方面的差异进行前瞻性研究。 结果 两组在手术中出血量及手术后并发症比较没有统计学意义，但在手术时间、术后胰瘘、术后住院时间等方面有统计学意义（P0.05）。 结论 相对于传统的胰十二指肠切除术中捆绑式胰肠吻合重建方式，连续胰肠吻合和Y形空肠内引流手术方式较容易掌握，且在术后管理上具有较为明显的优势。 【关键词】? 胰十二指肠切除;胰肠吻合,Y形空肠内引流;前瞻性研究;胰漏 ????? Abstact?? Objecive? To evaluate the application of Y-shape intra-enteric-cavitary drainage with continuous pancreaticoenterostomy in pancreaticoduodenectomy, and compare this technique with the traditional pancreaticoduodenectomy. Methods? One hundred and three cases undergone pancreaticoduodenectomy from Nov. 2004 to Nov. 2006 were reviewed． All of these patients was divided into two groups randomly. In the operation, the research group(n=55) received intra-enteric-cavitary drainage with continuous pancreaticoenterostomy, while the control group(n=48) received the conventional pancreaticoenterostomy. Data were analyzed by SPSS 13. Results? The median anastomosis time in patients of control group was significantly longer than that in research group. Although the postoperative complications had no significant difference in these two groups， the incidence of pancreatic fistula and the length of stay have the significant difference. Conclusions? Intra-enteric-cavitary drainage with continuous pancreaticoenterostomy technique can be easily mastered by an experienced surgeon， and the postoperative management seems too much simpler than the conventional method. ??? Keywords?? pancreaticojejunostomy； pancreaticoenterostomy, intra-enteric-cavitary drainage； prospective research胰瘘是胰十二指肠切除术（pancreaticoduodenectomy，PD）后最严重的并发症，且是PD术后导致患者死亡的常见原因，胰瘘一旦发生，其病死率高达40%以上。尽管现在临床上应用胃肠外营养和抑制胰腺分泌药物及通畅引流等来治疗胰漏，但只有防止胰瘘的发生才是手术成功和降低手术死亡率的关键。我科室2004年12月至2006年12月间接受胰十二指肠切除术患者103例，55例手术中重建时选择连续胰肠吻合和Y形空肠内引流，与同期开展的48例传统的捆绑式胰肠吻合的手术进行比较，效果满意，现