胰十二指肠切除术消化道重建方式的探讨  

Study on method of alimentary tract reconstruction in pancreaticoduodenectomy

作　　者：文军[1] 沈文律[1] 杨少华[1] 陈少逸[1] 郭国湖[1] 林李波[1] 

机构地区：[1]汕头大学医学院第二附属医院普通外科,515041

出　　处：《中国医师进修杂志（外科版）》2006年第6期24-26,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 探讨降低胰十二指肠切除术后并发症的措施。方法 回顾分析1998年1月-2004年12月，34例行胰十二指肠切除术患者的临床资料。29例患者采用胰十二指肠切除术消化道的重建：胰管-黏膜端侧胰肠吻合；对胰腺组织较软、胰管较细的5例患者，采用端-端胰肠套入吻合。胆道重建采用肝总管空肠端-侧吻合。胃肠的重建采用Roux-ell-Y胃空肠吻合。结果 住院病死率为零。发生术后并发症：切口感染4例（12％），胃排空延迟1例（3％），肺炎1例（3％），腹腔内积液1例（3％）以及胰肠吻合口漏1例（3％）。胰漏经保守治疗后痊愈。无腹腔内出血、腹腔内脓肿和其他吻合口漏发生。术后平均随访21个月（6个月～5年）。临床上未出现脂肪痢样腹泻、胆汁返流性胃炎、胃肠吻合口溃疡、胆道逆行感染和倾倒综合征的表现。术后无新增的糖尿病患者。结论 采用恰当的消化道重建方式可以有效地减少胰十二指肠切除术后并发症。Objective To explore the ways to decrease the postoperative complications of pancreaticoduodenectomy. Methods Thirty- four patients who underwent pancreatlcoduodenectomy between January 1998 and December 2004 were reviewed retrospectively. A duct - to- mucosa pancreaticojejunostomy was performed mostly for patients, and an end - to - end pancreaticojejunal invagination for 5 - patients with a soft pancreas and a small pancreatic duct. The end - to- side hepaticojejunostomy and the Roux - en - Y reconstruction of gastrointestinal continuity were performed for all patients. Results The hospital mortality was zero. The postoperative complications occurred in the form of wound infection was 4（12% ）, delayed gastric emptying was 1（3% ）, pneumonia was 1（3% ）, intraabdominal collections was 1（3% ） and pancreaticojejunostomy leak was 1（3% ）. In 1 patient with pancreatico- jejunostomy leak, the closure was achieved with the conservative treatment. Intra-abdominal Needing, intra-abdominal abscess and other anastornotic leakage were not seen in any of patients. The median follow- up was 21 months （ranging from 6 months to 5 years）, none of patients had clinical evidence of steatorrhea, bile reflux gastric disease, anastomotic ulcer, retrograde cholangitis and dumping syndrome, there was no new case of diabetes. Conclusions Proper method of reconstruction produces encouraging results in decreasing the complications after pancreaticoduodenectomy.

关 键 词：胰十二指肠切除术 重建 术后并发症 

分 类 号：R657.5[医药卫生—外科学] R738.1[医药卫生—临床医学]