瘘管切除胰腺空肠Roux-en-Y吻合治疗胰腺外瘘24例临床分析  

Clinical analysis of 24 cases of external pancreaticfistula patients treated by fistulectomy and Roux-en-Y pancreatojejunostomy

作　　者：朱晨宇[1] 朱耀明[1] 

机构地区：[1]湖北省宜昌市中心人民医院/三峡大学第一临床医学院普外科

出　　处：《临床外科杂志》2015年第3期179-180,共2页Journal of Clinical Surgery

摘　　要：目的：探讨胰腺外伤或胰腺炎经外引流后形成胰腺瘘管的手术方式及时机的选择。方法胰腺外伤或胰腺炎行外引流后胰腺瘘管再次手术病例45例，按是否行瘘管切除分为两组。其中A组21例行胰腺瘘管空肠 Roux-en-Y 形吻合；B 组24例采取胰腺瘘管切除及胰腺空肠Roux-en-Y形吻合，手术均选择在胰腺瘘管形成后4∽6个月。两组患者术后均常规使用生长抑素。结果 A组术后发生慢性腹痛6例，胰漏8例，消化道出血5例，切口感染9例。B组慢性腹痛1例，胰漏2例，消化道出血5例，切口感染3例。结论胰腺瘘管切除加胰腺空肠Roux-en-Y吻合术能够有效的降低胰腺外伤或胰腺炎外引流术后胰腺瘘管形成患者并发症发生率。Objective To evaluate the surgical management of pancreatic fistula caused by pan-creatic trauma and pancreatitis through surgical drainage. Methods A series of 45 patients with pancreat-ic fistula undergoing Roux-en-Y surgery with or without fistulectomy from 2004 to 2014 was analyzed. Pa-tients were divided into two groups：patients in group A（n=21）underwent external drainage of pancreatic secretion by Roux-en-Y surgery,and patients in group B（n= 24）underwent Roux-en-Y surgery with fistu-lectomy. The surgery was performed at 4~6 months after formation of the fistula,and somatostatin was used postoperatively. Results Patients in group A developed more severe side effects than patients in group B, including chronic abdominal pain（6/21 vs. 1/24）,pancreatic leakage（8/21 vs. 2/24）,digestive bleeding （5/21 vs. 5/24）and incision infection（9/21 vs. 3/24）. Conclusion Resection of the fistula plus Roux-en-Y surgery can significantly reduce the incidence of surgical complications,which is a safe and efficient management for pancreatic fistula.

关 键 词：胰腺瘘管 外引流术 再手术时机 

分 类 号：R657.5[医药卫生—外科学]