目的

探讨胰十二指肠切除术（PD）不同胰肠吻合方式对胰漏发生的影响。

方法

回顾2002年2月至2007年5月154例行胰十二指肠切除术病例，分别采取胰肠套埋单层吻合105例，双层吻合49例，分析与胰漏相关危险因素及两组间胰漏差异原因。

结果

胰漏发生率8.4%(13/154)，Logistic回归多变量分析表明：男性、胰腺质地软、非单层胰肠吻合方式是3个与胰瘘相关的独立变量；两种吻合方式间胰漏（单层吻合,4.8%vs 双层吻合,16.4%）、术后并发症（单层吻合,18.1%vs 双层吻合,32.7%）、术后平均住院时间(单层吻合,18.45±7.11天vs 双层吻合,22.75±9.73天)、质软胰腺中胰漏(单层吻合,6%vs 双层吻合,27.6%)有统计学差异。

结论

胰肠套埋单层吻合，特别是在质软胰腺中应用可明显减少胰漏发生率。

Objective

To analyze the possible difference in the incidence of pancreatic leakage relative to two methods of pancreaticoduodenectomy(PD).

Methods

A retrospective review of 154 consecutive patients who underwent PD between Feb 2002 and May 2007 was carried out. 105 cases were used a single-deck invaginated pancreaticojejunostomy, 49 cases were double-deck invaginated.Risk factors associated with leakage were determined for all 154 cases and then outcomes for each group were compared.

Results

Leakage was observed in13 of 154 cases (8.4%).Uni-and multivariate analysis showed three independent risk factors for leakage:male gender;not using a single-deck invaginated pancreaticojejunostomy; soft pancreatic gland.The leakage rate in the single-deck group was 4.8%（5 of 105）and in the double-deck group was 16.4%(8 of 49,P=0.016).The postoperation complication was 18.1%in single-deck group while 32.7%in the double-deck group.The mean length of stay after PD was longer in the double-deck group (22.75±9.73 days)as compared to the single-deck group (18.45±7.11 days).The leakage rate was 6%in the single-deck group vs 27.4%in the double-deck group(P=0.014).

Conclusion

The single-deck invaginated pancreaticojejunostomy decreases leakage significantly,particularly when a patient has soft pancreatic gland.