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

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

杨思捷¹,
张辉²,
王正峰²,
史志龙¹,
周文策^{1, 2, ,}

1.
兰州大学第一临床医学院，兰州 730000
2.
兰州大学第一医院普外科，兰州 730000

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)

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：杨思捷负责课题设计，资料分析，撰写论文；史志龙参与收集数据，修改论文；张辉、王正峰、周文策负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
周文策，zhouwc129@163.com

中图分类号: R657.5
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出版历程
- 收稿日期: 2020-12-15
- 录用日期: 2021-01-19
- 出版日期: 2021-07-20

Effect of Braun anastomosis on delayed gastric emptying after pancreaticoduodenectomy

1.
The First Clinical Medical College, Lanzhou University, Lanzhou 730000, China
2.
Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, China

Research funding:

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

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。
- 吻合术, 外科 /
- 胰十二指肠切除术 /
- 胃排空
Abstract: Objective To investigate the effect of Braun anastomosis (BE) on delayed gastric emptying (DGE) after pancreaticoduodenectomy (PD). Methods A retrospective analysis was performed for the clinical data of 132 patients who underwent PD in The First Hospital of Lanzhou University from December 2016 to December 2019, and according to whether BE was performed during surgery, the patients were divided into BE group with 54 patients and non-BE group with 78 patients. The two groups were compared in terms of postoperative complications (DGE, pancreatic fistula, and biliary fistula), intraoperative condition, general examination indicators, postoperative treatment and recovery, and hospitalization to evaluate the effect of BE in preventing DGE after PD. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test and the Fisher's exact test were used for comparison of categorical data between two groups. Results Compared with the non-BE group, the BE group had a significantly lower incidence rate of grade C DGE after surgery (5.56% vs 19.23%, χ²=5.067, P < 0.05), a significantly shorter time to the first chemotherapy [45.00 (38.00-49.75) days vs 53.00 (44.00-65.00) days, H=-2.495, P=0.013], a significantly shorter length of postoperative hospital stay [15.00 (12.75-19.25) days vs 18.00 (15.00-25.50) days, H=-3.358, P < 0.05], and a significantly lower number of times of the use of antiemetic drugs [1.00(0-0.25) times vs 1.00(1.00-4.00) times, H=-2.347, P=0.019]. There were no significant differences between the two groups in the time of operation, intraoperative blood loss, hospital cost, survival time, duration of gastric tube placement, time to resume eating, and overall incidence rates of DGE, pancreatic fistula, biliary fistula, gastrointestinal fistula, abdominal bleeding, incision infection, wound dehiscence, and intestinal obstruction (all P > 0.05). Conclusion BE can effectively reduce the incidence rate of grade C DGE after PD.
- Anastomosis, Surgical /
- Pancreaticoduodenectomy /
- Gastric Emptying

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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值
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

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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值
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

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表 3 术后其他治疗指标

指标	BE组(n=54)	非BE组(n=78)	H值	P值
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

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