术后胰漏的治疗分析.pdfVIP

主堡 胆夕} 声2007年12月第13卷第12期 Chin J Hepatobiliary Surg，December 2007，Vo1．13，No．12 · 论著 · 术后胰漏的治疗分析 徐彬 靳大勇 周晓晖 施晨晔 戎叶飞 楼文晖 【摘要】 目的 探讨胰腺手术后胰漏的治疗方式。方法 前瞻性收集42例胰腺手术后病人的 腹腔内引流液行淀粉酶测定，严格以术后3 d或者以上，腹腔引流液淀粉酶测定值大于正常血清淀粉 酶测定值上限3倍作为胰漏诊断标准，将术后出现胰漏的病人分为3级，针对不同分级采用具体的治 疗措施。结果 42例病人中有 12例出现胰漏，发生率为 28．5 。其中I级胰漏 8例，占胰漏的 66．67 ；lI级胰漏4例，占胰漏的33．33 ；未见Ⅲ级胰漏。I级和Ⅱ级胰漏之间腹腔引流管留置时 间、术后住院时间均无差别(PO．05)。胰漏病人中无1例死亡，经相应处理，胰漏均能愈合，但腹腔 引流管留置时间将明显延长(P一0．007)。结论 胰漏应分级治疗，I级胰漏通畅引流即可愈合，Ⅱ ～ Ⅲ级胰漏要积极治疗。 【关键词】 手术后并发症； 胰漏； 治疗 Analysis of treatment of postoperative pancreatic fistula XU Bin，J IN Da—yong，ZH0U Xiao—hui，et a1．Pancreatic Tumor Group，Department of General Surgery，Zhongshan Hospital，Fudan Uni— versity，Shanghai 200032，P．R．China [Abstract] Objective To investigate proper management of postoperative pancreatic fistula (POPF)．Methods The postoperative intra abdominal drainage liquid was prospectively collected for determination of amylase activity from patients with pancreatic operations．Pancreatic fistula was de— fined when the amylase activity of intra——abdominal drain fluid exceeded 3 times the serum amylase ac—— tivity on the 3 rd postoperative day and thereafter．Three different grades of P0PF(grades 1，2，3) were defined according to the clinical impact on the patients hospital course．Corresponding therapeu— tic measures were taken according to the different grades．Results Among 42 patients receiving pan— creatic surgery，P0PF was observed in 12．There were 8 cases 0f grade I and 2 Of grade 1I and no case of gradeⅢ was observed．No statistical significance was observed in postoperative hospital stay and draining time between the grade I and grade 1I pancreatic fistula．There was no operative or hospital death．The patients with P0PF were finally cured，but had longer duration of therapy for drainage (P一0．007)．Conclusion Proper therapeutic measures for P0PF are adv