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腔内引流技术预防胰十二指肠切除术后B、C级胰漏

The effect of drainage in cavities on preventing from grade B and C of the pancreatic fistula after pancreaticoduodenectomy

摘要:

目的 探讨腔内引流技术在预防胰十二指肠切除术(PD)后B、C级胰漏中的作用.方法 选择2008年6月至2010年6月施行PD的68例患者,男性43例,女性25例,平均年龄(64±3)岁.按PD切除后引流方案分为腔内引流组(腔内组)32例与常规引流组(常规组)36例.收集相关临床病理资料,比较两组引流液性状、胰漏发生率、胰漏严重度分级的差异.结果 腔内组引流液中未见胆汁,淀粉酶为(1401 ±8) U/L,胰周总引流量为(49±5)ml;常规组引流液淀粉酶为(2160±13)U/L,胰周总引流量为(76±4)ml;两组引流量差异有统计学意义(=2.597,P =0.031),引流液淀粉酶差异无统计学意义(P>0.05).腔内组胰漏发生率25.0%(8/32),均为A级胰漏;常规组胰漏发生率30.5%(11/36),A级胰漏6例,B、C级胰漏共5例.两组胰漏发生率比较差异无统计学意义(P>0.05),B、C级胰漏发生率差异有统计学意义(x2=4.797,P=0.029).结论 腔内引流技术可达到体腔内液体充分引流及胆胰液分离的治疗要求,并降低术后B、C级胰漏的发生率.

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abstracts:

Objective To explore the effect of drainage in cavities on preventing from grade B and C of the pancreatic fistula after pancreaticoduodenectomy (PD).Methods From June 2008 to June 2010,the medical team had performed the operations of digestive tract reconstruction by the same way in 68 cases with PD.There were 43 male and 25 female patients,with a mean age of (64 ± 3) years.The patients were simply randomly divided into drainage in cavities group (DC,n =32) and conventional drainage group (CD,n =36) according to the different drainage way.The methods of drainage in cavities were composed of three aspects which include drainage in main pancreatic duct,drainage around cholecystojejunostomy anastomosis and peripancreatic drainage.The clinical parameters of the two groups were collected.The characteristics of the drainage juice which include color,volume and amylase value in the two groups were compared.The incidence and severity grading of pancreatic fistula between the two groups were evaluated.Results The average of amylase value and the peripancreatic drainage flow were (1401 ±8) U/L and (49 ±5) ml in the DC group.Their average in the CD group were (2160 ± 13) U/L and (76 ±4) ml.There was significant statistical difference in the peripancreatic drainage flow between the two groups (t =2.597,P =0.031).The amylase values of the drainage juice between the two groups were of no statistical difference (P >0.05).According to the definition of pancreatic fistula by an international study group,the incidence of pancreatic fistula in the DC group was 25.0% (8/32) and the CD group 30.5% (11/36) (P >0.05).The proportion of grades B and C of pancreatic fistula in the DC group had statistical difference compared with one of the CD group (x2 =4.797,P =0.029).Conclusion Drainage in cavities could significantly decrease and the occurring ratio of grade B and C of pancreatic fistula after PD.

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