胰十二指肠切除术后近期非计划性再手术56例临床分析  

Clinical analysis of short-term unplanned reoperation after pancreatoduodenectomy in 56 cases

作　　者：华啸 张双民[2] 唐晓燕[2] 

机构地区：[1]内蒙古呼伦贝尔市人民医院普外科,021008 [2]中国医学科学院中国协和医科大学北京协和医院,100730

出　　处：《中国肿瘤临床与康复》2010年第3期236-238,共3页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的通过对胰十二指肠切除术后近期再手术病例的临床分析,探讨胰十二指肠切除术后近期非计划性再手术的原因、预防及处理措施。方法对北京协和医院2000年3月至2009年8月收治的56例胰十二指肠切除术后近期因不同原因非计划性再手术患者的临床资料进行回顾性分析,分析再手术原因、诊断及再手术方式。结果再手术56例中,腹腔大出血16例,上消化道大出血11例,胰漏7例,腹腔脓肿5例,肠梗阻4例,胃排空障碍2例,腹腔引流管断裂2例,阴性再手术2例,胆漏2例,切口裂开5例。再次手术后死亡7例,余痊愈。再手术死亡率12.5%。结论加强围手术期管理,术中精细操作,合理放置引流管以充分引流,加强术后观察,提高首次手术质量,是提高胰十二指肠切除术疗效的关键,而合理掌握再手术指征、实施及时有效的再次手术可以避免疾病进一步恶化。Objective To probe the causes,precautions and treatment of unplanned reoperation after pancreatoduodenectomy according to the analysis of 56 cases.Method A retrospective analysis was made for the clinical data of 56 cases of unplanned reoperation after pancreatoduodenectomy from March 2000 to August 2009 in Peking Union Medical College Hospital.Results Among 56 cases of reoperation,the causes of unplanned reoperation were massive abdominal bleeding in 16 cases,upper gastrointestinal bleeding 11 cases,pancreatic leakage 7 cases,abdominal abscess 5 cases,ileus 4 cases,delayed gastric emptying 2 cases,peritoneal drainage tube rupture 2 cases,reoperation without findings 2 cases,biliary leakage 2 cases,incision rupture 5 cases.Death of reoperation occurred in 7 cases,with the mortality being 12.5%,others recovered.Conclusions Enhancing the perioperative management,meticulous operative manipulation,reasonable placing the drainage tube for full drainage,observation after the operation and improving the quality of the first operation are the key points of the pancreatoduodenetomy.Comprehensive indications for reoperation and effective reoperation in time can avoid the exacerbation of the diseases.

关 键 词：胰十二指肠切除术 并发症 非计划性再手术 

分 类 号：R735.9[医药卫生—肿瘤] R730.56[医药卫生—临床医学]