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Braun吻合对胰十二指肠切除术后胃排空延迟的影响

杨思捷 张辉 王正峰 史志龙 周文策

杨思捷, 张辉, 王正峰, 等. Braun吻合对胰十二指肠切除术后胃排空延迟的影响[J]. 临床肝胆病杂志, 2021, 37(7): 1652-1656. DOI: 10.3969/j.issn.1001-5256.2021.07.034
引用本文: 杨思捷, 张辉, 王正峰, 等. Braun吻合对胰十二指肠切除术后胃排空延迟的影响[J]. 临床肝胆病杂志, 2021, 37(7): 1652-1656. DOI: 10.3969/j.issn.1001-5256.2021.07.034
YANG SJ, ZHANG H, WANG ZF, et al. Effect of Braun anastomosis on delayed gastric emptying after Pancreaticoduodenectomy[J]. J Clin Hepatol, 2021, 37(7): 1652-1656. DOI: 10.3969/j.issn.1001-5256.2021.07.034
Citation: YANG SJ, ZHANG H, WANG ZF, et al. Effect of Braun anastomosis on delayed gastric emptying after Pancreaticoduodenectomy[J]. J Clin Hepatol, 2021, 37(7): 1652-1656. DOI: 10.3969/j.issn.1001-5256.2021.07.034

Braun吻合对胰十二指肠切除术后胃排空延迟的影响

DOI: 10.3969/j.issn.1001-5256.2021.07.034
基金项目: 

甘肃省科技厅重点研发基金资助项目 17YF1FA128

甘肃省卫生行业科研计划项目 GSWSKY2018-51

详细信息
    通讯作者:

    周文策,zhouwc129@163.com

  • 中图分类号: R657.5

Effect of Braun anastomosis on delayed gastric emptying after pancreaticoduodenectomy

Funds: 

The Key Research and Development Fund Project of Gansu Provincial Department of Science and Technology 17YF1FA128

Research Program of Gansu Province Health Industry GSWSKY2018-51

  • 摘要:   目的  探讨Braun吻合(BE)对胰十二指肠切除术(PD)术后胃排空延迟(DGE)的影响。  方法  回顾性分析2016年12月—2019年12月在兰州大学第一医院行PD的132例患者的临床资料,根据术中是否行BE分为BE组(n=54)和非BE组(n=78)。比较两组患者术后DGE、胰瘘、胆瘘等并发症、术中情况、一般检查指标、术后治疗及恢复情况、住院总体情况,评估BE对预防PD术后DGE的影响。正态分布的计量资料两组间比较采用t检验,非正态分布的计量资料两组间比较采用Mann-Whitney U检验,计数资料两组间比较采用χ2检验和Fisher精确检验。  结果  与非BE组相比,BE组术后C级DGE发生率明显降低(5.56% vs 19.23%,χ2=5.067,P<0.05),第1次化疗时间较早[45.00(38.00~49.75) d vs 53.00(44.00~65.00)d,H=-2.495,P=0.013],术后住院时间也明显较短[15.00 (12.75~19.25)d vs 18.00 (15.00~25.50)d,H=-3.358,P<0.05],止吐药物使用次数亦显著减少[1.00 (0~0.25)次vs 1.00 (1.00-4.00)次,H=-2.347,P=0.019]。而两组患者手术时间、术中出血量、住院费用、生存时长、胃管持续时间、恢复饮食时间以及总体DGE发生率、胰瘘、胆瘘、胃肠瘘、腹腔出血、切口感染、伤口裂开、肠梗阻的发生率,差异均无统计学意义(P值均>0.05)。  结论  Braun吻合可有效降低PD术后C级DGE的发生率。

     

  • 表  1  两组患者一般资料比较

    指标 BE组(n=54) 非BE组(n=78) 统计值 P
    男/女(例) 33/21 46/32 χ2=0.061 0.806
    年龄(岁) 62.0(53.5~66.0) 56.0(50.0~67.0) H=-1.565 0.118
    BMI(kg/m2) 23.21±2.92 22.62±3.36 t=1.032 0.304
    WBC(×109/L) 5.71(4.59~7.55) 5.75(4.46~7.10) H=-0.429 0.466
    RBC(×1012/L) 4.38±0.60 4.32±0.66 t=0.559 0.577
    PLT(×109/L) 236.76±85.30 218.69±73.30 t=1.301 0.195
    Hb(g/L) 133.56±3.06 133.55±2.53 t=0.001 0.999
    ALT(U/L) 133.00(43.75~254.00) 115.00(40.50~245.00) H=-0.206 0.837
    AST(U/L) 117.50(35.50~201.25) 79.00(38.50~183.50) H=-0.818 0.413
    TBil(μmol/L) 153.60(22.43~280.40) 134.60(20.35~238.95) H=-0.727 0.467
    Alb(g/L) 41.30(37.68~43.48) 40.60(38.05~43.35) H=-0.388 0.698
    糖尿病(例) 11 15 χ2=0.026 0.871
    高血压(例) 12 17 χ2=0.003 0.954
    病理分型[例(%)]
        胰头恶性肿瘤 16(29.63) 25(32.05) χ2=0.087 0.768
        胰头良性疾病 4(7.41) 6(7.69) χ2=0 1.000
        胆管下段恶性肿瘤 17(31.4) 26(33.33) χ2=1.643 0.896
        胆管下段良性疾病 1(1.85) 0 0.409
        壶腹部恶性肿瘤 5(9.26) 7(8.97) χ2=0.000 1.000
        十二指肠恶性肿瘤 11(20.37) 14(17.95) χ2=0.122 0.727
    出血量(ml) 300.00(200.00~400.00) 200.00(187.75~400.00) H=-0.655 0.512
    手术时长(min) 400(300~530) 360(320~430) H=-0.838 0.402
    下载: 导出CSV

    表  2  术后第1天生化指标、并发症及DGE发生率比较

    指标 BE组(n=54) 非BE组(n=78) 统计值 P
    WBC(×109/L) 14.29(11.40~18.23) 11.65(9.87~15.98) H=-2.402 0.016
    RBC(×1012/L) 3.76(3.38~4.02) 3.75(3.43~4.09) H=-0.157 0.875
    PLT(×109/L) 223.98±81.30 210.21±83.25 t=0.944 0.347
    Hb(g/L) 115.00(104.75~125.00) 115.50(103.00~126.00) H=-0.190 0.849
    AST(U/L) 76.50(52.75~120.25) 84.00(58.50~121.00) H=-0.310 0.756
    ALT(U/L) 93.00(49.75~150.50) 91.50(52.00~155.75) H=-0.245 0.806
    TBil(μmol/L) 101.10(25.60~162.45) 76.20(22.70~159.00) H=-0.461 0.645
    Alb(g/L) 30.00±3.88 31.25±3.61 t=-1.907 0.059
    并发症[例(%)]
        出血 9(16.67) 11(14.10) χ2=0.163 0.686
        DGE 50(92.59) 65(83.33) χ2=2.438 0.118
        胰瘘(B+C级) 6(11.11) 18(23.08) χ2=3.071 0.081
        胆瘘 3(5.56) 6(7.69) χ2=0.016 0.898
        胃肠瘘 1(1.85) 3(3.85) 0.644
        伤口感染 4(7.41) 10(12.82) χ2=0.986 0.321
        伤口裂开 0 2(2.56) 0.513
        腹腔感染 14(25.93) 17(21.79) χ2=0.303 0.582
        肠梗阻 1(1.85) 4(5.13) 0.648
    DGE发生率[例(%)]
        A级 27(50.00) 31(39.74) >0.05
        B级 20(37.04) 19(24.36) >0.05
        C级 3(5.56) 15(19.23) <0.05
        总体 50(92.59) 65(83.33) χ2=2.438 >0.05
    下载: 导出CSV

    表  3  术后其他治疗指标

    指标 BE组(n=54) 非BE组(n=78) H P
    胃管持续时间(d) 7.00(5.75~9.00) 7.00(5.00~11.25) -0.081 0.935
    恢复饮食时间(d) 9.00(7.00~12.00) 11.00(8.00~17.25) -1.709 0.087
    止吐药物使用次数(次) 1.00(0~0.25) 1.00(1.00~4.00) -2.347 0.019
    第1次化疗时间(d) 45.00(38.00~49.75) 53.00(44.00~65.00) -2.495 0.013
    术后住院时长(d) 15.00(12.75~19.25) 18.00(15.00~25.50) -3.358 0.004
    住院费用(元) 70 303.90(56 620.84~94 435.69) 78 455.30(67 485.51~97 124.42) -1.911 0.056
    下载: 导出CSV
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  • 收稿日期:  2020-12-15
  • 修回日期:  2021-01-19
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