胰十二指肠切除术中胰消化道重建方式对术后胰瘘发生的影响.docVIP

Hans Journal of Surgery外科, 2012, 1, 1-4 /10.12677/hjs.2012.11001 Published Online April 2012 (/journal/hjs) The Comparation of Different Pancreaticoenteric Reconstructions Designed to Prevent Pancreatic Fistula after Pancreatoduodenectomy Longhao Sun, Xianghui He, Tong Liu Department of General Surgery, Tianjin Medical University General Hospital, Tianjin Email: sun_longhao@, humphreyhe@163.com Received: Feb. 26th, 2012; revised: Mar. 10th, 2012; accepted: Mar. 21st, 2012 Abstract: Pancreaticoduodenectomy (PD) has become an increasingly matured and safe operation for selected patients with benign and malignant periampullary disorders. However, the postoperative morbidity rate is still high. Pancreatic fistula (PF) is the most problematic common complication after PD. This article reviews and compares the available data on the outcome of various methods of pancreaticoenteric reconstruction designed for the prevention of PF. This paper is designed to do a critical analysis of clinical literature including large series, meta-analyses, and prospective, randomized controlled trials (RCTs) in order to compare the different pancreaticoenteric anastomosis and get the best management. As a result, there is no universal agreement as to whether one procedure is safer and less prone to PF than the others. Keywords: Pancreaticoduodenectomy; Pancreatic Fistula; Pancreaticojejunostomy; Pancreaticogastrostomy; Pancreatic Duct Stent 胰十二指肠切除术中胰消化道重建方式对术后胰瘘发生的影响 孙龙昊，何向辉，刘 彤 天津医科大学总医院普通外科，天津 Email: sun_longhao@, humphreyhe@163.com 收稿日期：2012年 2月 26日；修回日期：2012年 3月 10日；录用日期：2012年 3月 21日 摘 要：胰十二指肠切除术被认为是治疗壶腹周围良恶性肿瘤的一种成熟安全的术式，但其术后并发症的发生 率仍高，而术后胰瘘是最常见的并发症之一。本文回顾并比较了目前为防止胰瘘发生而设计的各种胰消化道重 建术式效果的相关数据，旨在通过对各项大样本研究，meta分析，前瞻性研究，回顾性研究以及随机对照实验 进行客观严格的分析而寻找最有效的吻合术式。但遗憾的是，世界范围内目前并没有就任何一种术式较其他方 法存在优越性达成共识。 关键词：胰十二指肠切除术；胰瘘；胰肠吻合术；胰胃吻合术；胰管支架 1.引言 年在德国柏林Walter Kausch第一次成功进行了2阶段 的胰十二指肠切除术。1935年 Allen Whipple首次报 道了一系列成功进行的胰十二指肠切除术，从那时 起，这个术式开始被称为 Whipple术。随着