改良“双U法胰肠吻合”在胰十二指肠切除术的运用及效果评估

doi:10.16139/j.1007-9610.2024.01.06

摘要/Abstract

摘要：

目的：探讨“双U法胰肠吻合”改良前、后在胰十二指肠切除术中的疗效评估。方法：回顾性分析2022年1月至2023年9月于复旦大学附属肿瘤医院胰腺外科王巍团队行胰十二指肠切除术的150例病例资料。根据吻合方式改良与否，分为双U法1.0组（改良前70例）和双U法2.0组（改良后80例），比较两组术后并发症情况。结果：双U法2.0组术后总体并发症发生率较双U法1.0组显著降低（13.8%比38.6%，P=0.001）。双U法1.0组临床相关性胰漏发生率18.6%，而双U法2.0组6.3%，两组差异有统计学意义（P=0.021）。双U法1.0组术后腹腔出血5例，双U法2.0组术后仅1例出现上消化道出血。两组术后出血发生率差异有统计学意义（P=0.007）。双U法2.0组术后中位住院时间较双U法1.0组显著降低（11 d比14 d，P=0.001）。结论：改良后的“双U法胰肠吻合”可显著降低临床相关性胰漏及相关严重并发症发生率，有利于提高手术安全性。

关键词: 胰肠吻合, 双U法, 胰漏, 胰十二指肠切除术, 网膜垫

Abstract:

Objective To evaluate the efficacy of double U-stitch and modified “double U-stitch pancreaticojejunostomy” in pancreaticoduodenectomy. Methods We retrospectively analyzed the clinical information of 150 patients who underwent pancreaticoduodenectomy between January 2022 and September 2023 in Wang Wei’s team in department of pancreatic surgery, Fudan University Shanghai Cancer Center. The patients were divided into two groups according to the pancreaticojejunostomy method: the double U-stitch 1.0 group (70 cases before modification) and the double U-stitch 2.0 group (80 cases after modification). The postoperative complications of the two groups were compared. Results The overall postoperative complications were significantly lower in the double U-stitch 2.0 group as compared with the double U-stitch 1.0 group (13.8% vs. 38.6%, P=0.001). The incidence of clinically relevant pancreatic fistula was 18.6% in the double U-stitch 1.0 group, while this was significantly decreased in the double U-stitch 2.0 group (6.3%) (P=0.021). Postoperative extraluminal hemorrhage occurred in 5 patients in the double U-stitch 1.0 group, while in the double U-stitch 2.0 group, only one patient experienced postoperative intraluminal hemorrhage, the difference was statistically significant between two groups (P=0.007). The median postoperative length of hospital stay was significantly shorter in the double U-stitch 2.0 group than that in the double U-stitch 1.0 group (11 d vs. 14 d, P=0.001). Conclusions The modified “double U-stitch pancreaticojejunostomy” can significantly reduce the incidence of clinically relevant pancreatic fistula and other relevant severe complications, which helps improve the safety of the procedure.

Key words: Pancreaticojejunostomy, Double U-stitch, Pancreatic fistula, Pancreaticoduodenectomy, Omental flap

中图分类号:

R735.9

华杰, 施思, 孟庆才, 许航, 刘江, 梁晨, 王巍. 改良“双U法胰肠吻合”在胰十二指肠切除术的运用及效果评估[J]. 外科理论与实践, 2024, 29(01): 34-39.

HUA Jie, SHI Si, MENG Qingcai, XU Hang, LIU Jiang, LIANG Chen, WANG Wei. Application and evaluation of modified “double U-stitch pancreaticojejunostomy” in pancreaticoduodenectomy[J]. Journal of Surgery Concepts & Practice, 2024, 29(01): 34-39.

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Item	Double U-stitch 1.0 group(n=70)	Double U-stitch 2.0 group(n=80)	Statistical value	P value
Gender			0.845	0.358
Male	35（50.0）	46（57.5）
Female	35（50.0）	34（42.5）
Age (years)	60.5 ± 12.8	59.5 ± 9.4	0.516	0.614
BMI (kg/m²)			0.748	0.688
<18.5	3（4.3）	6（7.5）
18.5-23.9	43（61.4）	49（61.3）
≥24	24（34.3）	25（31.2）
Comorbidities			1.241	0.265
Yes	33（47.1）	45（56.3）
No	37（52.9）	35（43.7）
Preoperative waiting time (d)	4（1-13）	4（1-12）	1.127	0.267
ASA grade			1.805	0.406
Ⅰ	5（7.1）	5（6.2）
Ⅱ	65（92.9）	73（91.3）
Ⅲ	0	2（2.5）
Preoperative PTCD/ERCP	21/3	26/2	0.982	0.725
Preoperative total bilirubin (μmol/L)	15.7（5.5-191.2）	19.8（6.2-178.4）	1.059	0.544

Item	Double U-stitch 1.0 group(n=70)	Double U-stitch 2.0 group(n=80)	Statistical value	P value
Pancreas texture			0.022	0.982
soft	41（58.6）	47（58.8）
hard	29（41.4）	33（41.2）
Diameter of pancreatic duct			0.048	0.827
<3 mm	38（54.3）	42（52.5）
≥3 mm	32（45.7）	38（47.5）
Operative time (h)	6.0 ± 1.1	6.2 ± 0.9	1.212	0.234
Intraoperative blood loss (mL)	333 ± 362	270 ± 170	1.382	0.189
Operative method			0.655	0.537
OPD	24（34.3）	13（16.2）
LPD	33（47.1）	46（57.5）
RPD	13（18.6）	21（26.3）
Overall postoperative complications	27 (38.6%)	11 (13.8%)	12.160	0.001
Clavien-Dindo grade
Ⅰ~Ⅱ	20 (28.6)	8 (10.0)	8.481	0.004
≥Ⅲ	7 (10.0)	3 (3.8)	2.344	0.126
Grade B/C pancreatic fistula	13 (18.6)	5 (6.3)	5.367	0.021
Grade B/C bile leak	0	1 (1.3)	0.881	0.348
Grade B/C hemorrhage	5 (7.1)	1 (1.3)	5.576	0.007
Grade B/C delayed gastric emptying	1 (1.4)	0	1.151	0.283
DSA intervention	3 (4.3)	1 (1.3)	1.326	0.250
Intra-abdominal infection	5 (7.1)	2 (2.5)	1.809	0.179
Drainage of intra-abdominal collection	3 (4.3)	2 (2.5)	0.370	0.543
Reoperation	4 (5.7)	1 (1.3)	2.309	0.129
Perioperative death	0	0	-	-
Length of postoperative stay (d)	14（7-85）	11（8-36）	3.808	0.001