胰十二指肠切除术后胰瘘合并出血再手术方式探讨  

A reoperation method for pancreatic fistula with hemorrhage after pancreaticoduodenectomy

作　　者：吴文广[1,2] 吴向嵩[1,2] 李茂岚[1,2] 张林[1,2] 杨佳华[1,2] 丁琦晨[1,2] 曹阳[1,2] 翁昊 丁倩[1,2] 陆建华[1,2] 顾钧[1,2] 董平[1,2] 彭淑牖[3] 刘颖斌[1,2] 

机构地区：[1]上海交通大学医学院附属新华医院普外科 [2]上海交通大学医学院胆道疾病研究所,上海200092 [3]浙江大学医学院附属第二医院普外科,浙江杭州310009

出　　处：《中国实用外科杂志》2013年第9期773-775,共3页Chinese Journal of Practical Surgery

摘　　要：目的探讨胰十二指肠切除术(pancreaticoduodenectomy,PD)后胰瘘合并出血合理的再手术方式。方法2009年5月至2012年12月上海交通大学医学院附属新华医院共施行PD 143例,其中胰瘘合并出血3例,二次手术残胰行胰液外引流术、捆绑式胰肠吻合术和捆绑式胰胃吻合术各1例。结果 3例术后均未出现严重的并发症,其中第1例病人二次手术6个月后再次行胰液内引流术。结论捆绑式胰肠(胃)吻合以捆绑的方法替代直接缝合实现残胰的重建,是PD术后胰瘘合并出血值得尝试的手术方式。Objective To evaluate a reasonable reoperation method for pancreatic fistula with hemotrhage after pancreaticoduodenectomy. Methods From May 2009 to December 2012, 143 cases of pancreaticoduodenectomy （PD） were performed in Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Among them, 3 cases had pancreatic fistula with hemorrhage. Pancreatic juice external drainage, binding pancreatieojejunostomy, and binding pancreaticogastrostomy was performed in 1 case respectively for residual pancreatic reconstruction. Results Three cases had no serious complication and the first case underwent reopcration after 6 months for pancreatic juice internal drainage. Conclusion Binding pancreaticojejunostomy （pancreaticogast（ostomy） describes a new binding anastomosis technique instead of direct suture for residual pancreatic reconstruction in reoperation, and is worthy of operating method for pancreatic fistula with hemorrhage after PD.

关 键 词：胰十二指肠切除术 胰瘘 术后出血 再手术 捆绑式胰肠吻合术 捆绑式胰胃吻合术 

分 类 号：R6[医药卫生—外科学]