| Objective:Comparisons of pancreaticojejunostomy wrapped by hepatic round ligament and non-hepatic round ligament,To explore the safety and clinical application value of hepatic round ligament wrapping around pancreaticoenteric anastomosis to prevent pancreatic fistula after operation.Method:Retrospective analysis of the basic clinical data of 57 patients undergoing laparoscopic pancreaticoduodenectomy from January 2016 to June 2018,including 22patients undergoing percutaneous pancreaticojejunostomy combined with hepatic ligament(wrap around group),35 patients only underwent pancreaticojejunostomy(control group),comparing preoperative gender,age,preoperative total bilirubin,preoperative albumin,preoperative transaminase,BMI;intraoperative operative time Intraoperative blood loss,pancreatic texture,pancreatic duct diameter;postoperative postoperative gastric emptying delay,postoperative bile leakage,postoperative pancreatic fistula,postoperative bleeding,postoperative hospital stay,postoperative pancreatic drainage tube extubation Differences in time-related clinical indicators.Contrast analysis of pancreaticojejunostomy and hepatic ligament wrapping to prevent postoperative pancreatic fistula safety and clinical application value.Results:The preoperative age of the two groups was 64.05±3.54 in the wrap around group and 62.14±4.71)in the control group(t=1.626,P=0.110),P>0.05.Gender:9males and 13 females in the wrap around group,22 males and 13 females in the control group(χ~2=2.623,P=0.105),P>0.05.BMI:20.56±3.79 kg/m~2 in the wrap around group and 21.19±2.76 kg/m~2 in the control group(t=0.720,P=0.475),P>0.05.Preoperative transaminase:110.23±49.32 U/L in the wrap around group and 100.26±97.50 U/L in the control group(t=0.510,P=0.612),P>0.05.Preoperative albumin:34.57±4.85 g/L in the wrap around group and 34.55±3.44 g/L in the control group(t=0.019,P=0.985),P>0.05.Total bilirubin before operation:142.55±113.42μmol/L in wrap around group and 93.68±98.17μmol/L in control group(t=1.723,P=0.091),P>0.05.There was no significant difference between the two groups before operation,and the data of the two groups were comparable.Intraoperative time:384.09±52.70min in the wrap around group and 404.86±100.95 min in the control group(t=1.016,P=0.314),P>0.05.Intraoperative bleeding volume:411.36±299.18ml in the wrap around group,288.57±172.82 ml in the control group(t=1.750,P=0.090),P>0.05.Pancreatic duct diameter:wrap around group,9 cases were larger than or equal to 3mm,13 cases were smaller than 3mm,13 cases were larger or equal to than3mm in control group,22 cases were smaller than 3mm(χ~2=0.081,P=0.0776),P>0.05.Texture of pancreas:10 cases were hard,12 cases were soft,15 cases were hard,20 cases were soft(χ~2=0.037,P=0.0847),P>0.05.Postoperative complications included biliary leakage,bleeding and delayed gastric emptying(P>0.05).In terms of postoperative pancreatic fistula,there were 4 cases(18.2)in the wrap around group and 17 cases(48.6)in the control group(χ~2=4.135,P=0.042),P<0.05.The difference was statistically significant,indicating that the incidence of pancreatic fistula in the control group was higher than that in the wrap around group.In the aspect of extraction of pancreaticojejunostomy after operation,the wrap around group was 17.09±5.4 d and the control group was 20.37±4.61 d(t=2.443,P=0.018),P<0.05.The results showed that the pancreaticojejunostomy drainage tube was pulled out earlier in the wrap around group.In terms of the length of hospitalization after operation,the length of hospitalization in the wrap around group was 16.59±5.70days,while that in the control group was 22.06±6.55 days(t=3.220,P=0.020).P<0.05 indicated that the length of hospitalization in the wrap around group was shorter than that in the control group.Conclusion:Encapsulation of hepatic round ligament at pancreaticoenteric anastomosis can reduce the incidence of pancreatic fistula,reduce the hospital stay and extubation time after operation,which has important clinical application value. |
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