腹腔冲洗对根治性全胃切除术后胰瘘转归的影响  

Influence of abdominal irrigation on postoperative pancreatic fistula after radical total gastrectomy

作　　者：王楠[1] 何显力[1] 乔庆[1] 包国强[1] 吴涛[1] 郑波波[1] 鲁建国[1] 

机构地区：[1]中国人民解放军第四军医大学附属唐都医院普通外科,陕西西安710038

出　　处：《中国普通外科杂志》2014年第4期421-424,共4页China Journal of General Surgery

基　　金：国家自然科学基金资助项目(81200330)

摘　　要：目的:探讨预防性放置腹腔冲洗管治疗胃癌D2根治性全胃切除术后胰瘘的有效性和必要性。方法:将2012年3月—2013年9月间收治的196例胃癌D2根治性全胃切除术患者随机均分为对照组和观察组,对照组患者术毕常规放置腹腔引流管,观察组患者除常规放置腹腔引流管外,于胰腺腹侧上缘放置1根冲洗管,对发生胰瘘患者缓慢滴注生理盐水冲洗胰腺区域。比较两组胰瘘发生率,以及两组胰瘘患者术后腹腔引流液淀粉酶浓度、肠功能恢复时间及住院费用。结果:两组的胰瘘发生率差异无统计学意义(P>0.05),但观察组B+C级胰瘘发生率较对照组明显降低(P<0.05);两组术后胰瘘患者比较,观察组第3天淀粉酶浓度较明显下降,肠功能恢复时间缩短,住院费用明显减少(均P<0.05),但其他并发症发生率两组间差异无统计学意义(P>0.05)。结论:放置腹腔冲洗管对胃癌术后胰瘘具有较好的治疗效果,对于术中疑有胰腺损伤的患者建议预防性放置腹腔冲洗管。Objective： To investigate the effectiveness and necessity of the prophylactic placement of abdominal irrigation tube for postoperative pancreatic fistula （POPF） following D2 radical total gastrectomy. Methods： From March 2012 to September 2013, 196 patients undergoing D2 radical total gastrectomy were equally randomized into control group and observational group. Patients in control group underwent routine abdominal drainage tube placement whih, in addition to abdominal drainage tube placement, those in observational group had an irrigation tube placed at the antero-superior aspect of the pancreas, and by the latter tube, the cases who developed POPF underwent irrigation of the pancreatic region with normal saline instillation. The incidence of POPF between the two groups, and the amylase concentration in the postoperative drainage fluid, time to bowel fimction recovery and hospitalization costs in POPF cases between the two groups were compared. Results： The difference in the incidence of POPF between the two group had no statistical significance （P〉0.05）, but the incidence of grade B-C POPF in observational group was significantly decreased compared with control group （P〈O.05）. Comparison in POPF patients between the two groups showed that the amylase concentration in the postoperative drainage fluid was significantly decreased, time to bowel function recovery was significantly shortened and hospitalization cost is significantly reduced （all P〈O.O5）, but the incidence of other complications had no statistical difference （P〉O.05）. Conclusion： Prophylactic placement of abdominal irrigation tube has demonstrable therapeutic effect for POPF, which is recommended for use in those patients with suspected pancreatic injury during surgery：

关 键 词：胃肿瘤 胃切除术 胰瘘 预防和控制 腹腔冲洗 

分 类 号：R735.2[医药卫生—肿瘤]