胰胃吻合术在胰十二指肠切除术中的应用  

Pancreaticogastrostomy following pancreaticoduodenectomy

作　　者：姜金强[1] 韩玮[1] 王仕明[2] 林海[1] 何铁英[1] 陈启龙[1] 

机构地区：[1]新疆医科大学第一附属医院胰腺外科,新疆乌鲁木齐830000 [2]新疆生产建设兵团农四师医院外科,新疆伊宁835000

出　　处：《中国普通外科杂志》2013年第9期1179-1184,共6页China Journal of General Surgery

摘　　要：目的:探讨胰胃吻合术(PG)在胰十二指肠切除术(PD)中的临床应用。方法:回顾性分析2010年12月—2012年12月期间50例PD后行PG患者的临床资料。分析术后胰瘘与其他并发症的发生情况,并分析术中、术后情况及术后腹腔引流液淀粉酶浓度与胰瘘发生的关系。结果:50例手术均顺利完成,术后胰瘘发生率36.0%(18/50),其他并发症发生率为20.0%(10/50)。全组3例死亡,余患者治愈出院。统计分析显示,胰瘘的发生与患者年龄无关(P>0.05),B,C级胰瘘患者的住院时间明显长于A级胰瘘或无胰瘘患者(均P<0.05),术中出血量越大或术后腹腔引流液淀粉酶浓度高,胰瘘的发生几率或级别越高(均P<0.05)。结论:PG是PD后消化道重建的安全有效方式,可降低胰瘘的发生率;胰瘘并发腹腔出血、腹腔脓肿等可考虑外科干预。Objective： To evaluate the clinical application ofpancreaticogastrostomy （PG） after pancreaticoduodenectomy （PD）. Methods： the clinical data of 50 patients undergoing PG following PD from December 2010 to December 2012 were retrospectively analyzed, qlae incidences of postoperative pancreatic fistula and other complications were analyzed, and the relations of the occurrence of postoperative pancreatic fistula with various intra- and postoperative conditions and amylase concentration in peritoneal drainage fluid were also analyzed. Results： Operation was performed successfully in all the 50 patients. The incidence of postoperative pancreatic fistula was 36% （18/50）, and the incidence of other postoperative complications was 20% （10/50）. In the entire group, 3 cases died and the others were discharged with complete recorery. The statistical analysis showed that the occurrence of postoperative pancreatic fistula was not related to age of the patients （P〉0.05）,the length of postoperative hospital stay in patients with grade B or C pancreatic fistula was longer than that in patients with grade A or without pancreatic fistula （all P〈0.05）, and the larger the intraoperative blood loss or the higher the amylase concentration in peritoneal drainage fluid was, the greater the probability of the occurrence of postoperative pancreatic fistula or the higher the grade of pancreatic fistula would be （all P〈0.05）. Conclusion： PG is safe and effective procedure for digestive tract reconstruction after PD, and it may reduce the incidence of pancreatic fistula. Only if abdominal bleeding or abdominal abscess occurs should surgical intervention be considered.

关 键 词：胰十二指肠切除术 胰胃吻合术 胰腺瘘 

分 类 号：R657.5[医药卫生—外科学]