胰头十二指肠切除术胰瘘相关因素.docVIP

胰头十二指肠切除术胰瘘相关因素【摘要】 目的 探讨胰头十二指肠切除术胰瘘发生与残胰处理方法,残胰管处理方式等相关关系。 方法 回顾分析我院自1990年1月至2006年12月所行67例胰头十二指肠切除术,其中Child法重建66例,Whipple法重建1例,残胰管内置短管引流65例,长管引流2例。结果 全组67例均无手术死亡,无胰瘘发生,胆瘘1例,应激性溃疡出血6例。 结论 胰瘘的发生与胰吻合方式关系不大,残胰管内置引流管能起到时明显降低胰瘘发生作用,而全胃肠外营养(TPN)的使用及生长抑素的应用能起到预防胰瘘发生的作用。 【关键词】胰头十二指肠切除术;胰瘘 The correlation factor affect pancreatic fistula after pancreatoduodenectomy QU Yi-meng,LUO Yong-ping, LIAN Fu-zhen,et al. Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangdong University of Pharmacy, Guangzhou 510080, China 【Abstract】 Objective To investigate the correlationship between pancreatic fistula after pancreatoduodenectomy and the way of dealing with residual pancreas and residual pancreatic duct. Methods 67 patients underwent pancreatoduodenectomy, 66 of whom were performed Child reconstruction and the remaining one patient undergoing Whipple procedure. With regard to the residual pancreatic duct drainage, 65 patients had short- tube drainage, whereas 2 cases were applied long-tube drainage. Results with 0% mortality and pancreatic fistula, one cases of biliary fistula, and six cases of stress ulcer bleeding were found and managed. Conclusions The occurrence of pancreatic fistula has little to do with the way of dealling with residual pancreatic. Pancreatic residual duct with drainage tube can significantly reduce occurrence of pancreatic fistula, and the use of TPN and the application of somatostatin can play a preventive role in the occurrence of pancreatic fistula. 【Key words】 Pancreatoduodenectomy;Pancreatic fistula 作者单位:510080广东药学院附属第一医院肝胆外科 胰头十二指肠切除术是治疗壶腹周围癌的主要手术方法,该手术复杂、创伤大。虽然近年来在一些外科治疗中心和专长于胰腺外科的医师中,此手术的死亡率已明显下降。但在一般情况下,手术死亡率仍然在15%左右,且手术的并发症很高[1]。胰瘘是胰头十二指肠切除术后的常见并发症和死亡的原因。胰瘘的发生与残胰的处理方法是否适当,胰液分泌和全胃肠外营养支持有相当重要的关系。本院从1990年1月至2006年12月共施行胰头十二指肠切除术67例,无手术死亡及胰瘘的发生。现报告如下: 1 临床资料 1.1 一般资料 本组67例,男52例,女15例。年龄22~75岁。病理诊断为:壶腹癌和乳头癌48例,胰头癌19例。 1.2 手术方式 本组病例行胰头十二指肠切除术后,采用Child法重建术66例,Whipple法重建术1例。胰液引流方式均于残胰内置引流管,其方法为残胰管内置入相适应硅