胰十二指肠切除术198例疗效分析  

Application of the placement of pancreatic duct sents and external drainage in pancreatoduodenectomy: an analysis of 198 cases

作　　者：许朱定[1,2] 张海斌[2] 沈翔 杨宁[2] 付雍[2] 杨广顺[2] 

机构地区：[1]解放军359医院外科,江苏镇江212001 [2]第二军医大学东方肝胆外科医院肝外五科,上海200438

出　　处：《东南国防医药》2013年第5期436-438,共3页Military Medical Journal of Southeast China

基　　金：上海市科委医学引导基金(10411963200)

摘　　要：目的总结分析198例胰十二指肠切除术(pancreaticoduo denectomy,PD)临床治疗效果,以期减少术后胰漏(postoperative pancreatic fistula,POPF)的发生。方法回顾性分析2003年4月-2013年3月完成的198例PD的临床资料。全组病例均采用Child方式重建消化道,胰肠吻合采用胰腺残端空肠两层对端吻合,胰管内置支撑引流管外引流。结果全组无手术死亡,术中有3例通过手术放大镜寻见胰管,1例胰管未找见而采用胰腺残端结扎;全组无胰漏发生,有4例胃排空障碍;胰腺残端结扎病例出现胰腺炎、胃排空障碍,经生长抑素、胃肠减压及营养支持等治疗后痊愈。结论术中尽量寻找胰管断端,内置引流管并引出体外,避免了胰酶激活对吻合口的腐蚀,是避免术后胰漏的关键所在。Objective To Investigate the clinical effect of 198 cases of pancreaticoduodenectomy （PD） ,in order to decrease incidence of pancreatic leakage. Methods The clinical data of 198 cases of PD admitted between April 2003 to March 2013 at the Second Military Medical University was analyzed retrospectively. All patients used the way of Child to reconstruction; Pancreaticojeju- nostomy（PJ） used remnant pancreatico-jejunum end-to-end anastomosis; pancreatic duct were used the placement of pancreatic duct sents and drainage external. Results No death and no pancreatic leakage ocurred. Panceatic duct was found by magnifier in 3 cases and not found in l case,which followed by suture and hgature the pancreatic remnant. Gastroparesis was found in 4 cases,treated by na- sogastric suction, total parenteral nutrition（TPN） ;and the patient with pancreatis treated with somatostatin analogues and TPN. Conclu- sion The the placement of pancreatic duct sents and external drainage are the key measure to prevent the pancreatic leakage in PD.

关 键 词：胰十二指肠切除术 胰肠吻合 胰管外引流 胰漏 

分 类 号：R656.64[医药卫生—外科学]