改良单层胰肠吻合术在胰十二指肠切除术带蒂大网膜包埋中的应用

目的:探讨带蒂大网膜包埋的改良单层胰肠吻合法重建消化道的胰十二指肠术的临床疗效。方法:回顾性分析2012年9月-2014年12月在我院行胰十二指肠切除术带蒂大网膜包埋改良单层胰肠吻合术的34例患者的临床资料。统计患者的手术时间、胰肠吻合时间、术后出血量、住院时间以及并发症的发生情况。结果:(1)手术平均时间(2.9±1.4)h,胰肠吻合平均时间(14±2.1)min,术后平均出血量(380±60)m L。所有患者经治疗后均治愈出院,住院时间平均(13.0±2.4)天。(2)术后并发症发生率为8例(23.5%),其中胰瘘2例(5.8%),为A级胰瘘;腹部感染3例(8.8%);腹腔出血2例(5.8%);胃排空延迟1例(2.9%)。无手术死亡者,无因严重并发症需要再次手术者。术后病理学诊断胰头癌18例,胆总管下癌8例,壶腹部癌5例,十二指肠乳头癌3例。结论:带蒂大网膜包埋的改良单层胰肠吻合能够减少术后胰瘘、出血、感染等并发症,提高手术成功率,值得临床进一步推广。

Pancreaticoduodenal Resection of Improving Pedicle Greater OmentumEmbedding in Single Application Experience of Pancreatic Anastomosis

Objective:To explore the clinical effect of improved single pancreatic anastomosis method with pedicle greateromentum embedding in the reconstruction of digestive tract of pancreatic duodenal decompression.Methods:The clinical data of 34patients with improved single layer anastomosis of pancreas and duodenum who were treated in our hospital from September 2012 toDecember 2014 were retrospectively analyzed. Then the operation time, blood loss, time of the anastomosis, the hospitalization andpostoperative complications were analyzed,Results:(1)The average time of operation was (2.9 ± 1.4) h, the average time of theanastomosis was (14± 2.1) min, and the average bleeding volume was (380± 60) mL. All patients were cured and discharged after thetreatment, and the average length of hospital stay was (13± 2.4) days. (2)The incidence of postoperative complications was observed in 8cases (23.5%), including 2 cases of pancreatic fistula (5.8%) classified in A grade, 3 cases of abdominal infection (8.8%), 2 cases ofabdominal cavity hemorrhage (5.8%), 1 case of delayed gastric emptying (2.9%). There were not patients died because of the operation orrequired reoperation because of serious complications. Pathological diagnosis after the operation included 18 cases of pancreatic headcarcinoma 8 cases of bile duct carcinoma, 5 cases of carcinoma of the stomach and 3 cases of duodenal papilla carcinoma.Conclusion:The improved single pancreatic anastomosis method with pedicle greater omentum embedding can reduce postoperative complicationssuch as pancreatic fistula, bleeding, infection and so on, improve the success rate of operation, so it is worthy of clinical promotion.