重症急性胰腺炎术后合并肠漏15例临床分析  

Treatments for postoperative intestinal leakage complicated with severe acute pancreatitis

作　　者：周渝阳[1] 皮儒先[1] 唐春[1] 陈平[1] 

机构地区：[1]第三军医大学第三附属医院野战外科研究所肝胆外科,重庆400042

出　　处：《海南医学院学报》2009年第11期1451-1453,共3页Journal of Hainan Medical University

基　　金：海南医学院科研基金资助学报项目(0020090251)~~

摘　　要：目的：探讨重症急性胰腺炎（severeacute Pancreatitis，SAP）术后并发肠漏的临床诊治经验。方法：回顾2006年1月～2008年12月，我院收治的71例SAP患者术后并发15例肠漏的临床资料，分析肠漏的诊治方法。结果：71例SAP患者并发肠漏15例，肠漏发生率21．1％。其中十二指肠降部及水平部漏8例，上段空肠漏1例，上段空肠漏＋升结肠漏1例，结肠漏5例。8例患者经过肠内营养支持、腹腔局部冲洗引流＋负压吸引等保守治疗措施治愈。7例患者因引流不畅，通过手术改善引流。其中1例结肠漏患者因再次手术后引流不充分，感染加重，后出现多器官功能衰竭死亡。其余6例实施各型手术治疗，其中2例十二指肠漏患者同时于再次腹腔引流术中行胃造口及双空肠造口术；1例空肠漏患者行漏口段局部空肠切除空肠对端吻合术；2例结肠漏患者行末端回肠造口、腹腔引流术；1例上段空肠漏＋升结肠漏患者行经口放置空肠营养管，并行末端回肠造口、腹腔引流术。再次手术患者术后加强营养，维持水电解质平衡，抗感染等治疗，同时行腹腔冲洗、负压引流，均治愈出院。结论：SAP术后并发肠漏是常见并发症之一，诊断主要通过消化道造影。处理重在预防。治疗应充分考虑原发病的状况，并根据肠漏的位置、局部炎症的情况、早期通过加强营养支持，保持漏口周围引流通畅．多数肠漏可自行愈合，后期少数不愈合肠漏可考虑手术治疗。Objective： To explore effective treatments for postoperative intestinal leakage complicated with severe acute pancreatitis （SAP）. Methods： Clinical data of 71 SAP cases that were hospitalized in our hospital from January 2006 to December 2008 were retrospectively reviewed. 15 cases that experienced postoperative complication of intestinal leakage were analyzed in order to explore effective treatments for intestinal leakage. Results： Of the 71 cases, 15 experienced postoperative intestinal leakage with an incidence of 21.1% including descending and horizontal parts of duodenum leakage in 8 cases ; upper jejunum leakage in 1 case ; upper jejunum and ascending colon leakage in 1 case, and colon leakage in 5 cases. $ of the 15 intestinal leakage patients were cured by conservative treatments including enteral nutrition support, intra - abdominal local irrigation and drainage plus suction; 7 patients had to undergo a second surgery to improve the inadequate drainage. Of the 7 cases, 1 died of aggravated infection resulted from inadequate drainage after the surgery, 6 recovered after comprehensive treatments including various types of surgery, enteral nutrition support, maintenance of water and electrolyte balance, intra - abdominal local irrigation and drainage plus suction. The surgery procedures included intra - abdominal local irrigation and drainage, gastrostomy plus jejunostomy performed on 2 duodenal leakage cases, localized jejunectomy plus jejunum end -to -end anastomosis for 1 jejunum leakage case, intra -abdominal local irrigation and drainage plus ileostomy on 2 ileum cases, and nutrient canal placement, ileostomy and intra- abdominal local irrigation and drainage on 1 upper jejunum and ascending colon leakage case. Conclusion： As a common postoperative complication of SAP, Intestinal leakage is preventable. It is mainly diagnosed by gastrointestinal contrast, its treatment should be correlated with state of primary disease, localization of the leakage, severity of inflammation. Most of the inte

关 键 词：重症胰腺炎 肠瘘 外科手术 

分 类 号：R657.51[医药卫生—外科学]