贯穿缝合式胰肠吻合术后单纯性胰瘘19例临床分析  

Pure pancreatic fistula after end to side penetrating-suture pancreaticojejunostomy:A clinical analysis of 19 cases

作　　者：黄建军[1] 陈益君[1] 朱学峰[1] 朱永胜[1] 顾晶[1] 

机构地区：[1]泰兴市人民医院普通外科,江苏泰兴225400

出　　处：《中国实用外科杂志》2015年第5期546-548,共3页Chinese Journal of Practical Surgery

摘　　要：目的探讨胰十二指肠切除+贯穿缝合式胰肠吻合术后单纯性胰瘘的发生、发展及预后。方法回顾性分析2005年5月至2013年7月泰兴市人民医院普外科收治的48例行胰十二指肠切除病人的临床资料,胰肠吻合方法均采用贯穿缝合式胰肠吻合术。参照国际胰瘘研究小组(ISGPF)的诊断与分级标准进行诊断和分级;同时根据胰瘘的性质将胰瘘分为单纯性胰瘘及胰肠吻合口瘘。结果 48例病人中术后共发生胰瘘19例(39.6%),其中A级胰瘘16例,B级胰瘘3例。经吻合口造影证实吻合口无渗漏,均为单纯性胰瘘。胰腺质地软脆者胰腺瘘发生率(16/31,51.6%)高于胰腺质地硬者(3/17,17.6%),差异有统计学意义(P<0.05)。全组无再次手术及手术死亡病例,均通过单纯引流治愈。结论贯穿缝合式胰肠吻合术后胰瘘发生率相对较高,但均为单纯性胰瘘,引流处理后预后良好。Objective To investigate the occurrence, development and prognosis of pure pancreatic fistula after pancreaticoduodenectomy and pancreaticojejunostomy. Methods The clinical data of 48 cases of pancreaticoduodenectomy performed from May 2005 to July 2013 in Taixing People＇ s Hospital were analyzed retrospectively. All patients performed end to side penetrating-suture pancreaticojegunostomy. Diagnosing and grading the cases were according to the diagnostic and grading standard Ⅱ of ISGPF. All the cases were classified into pancreatic fistula and pure pancreatic fistula according to their characteristics. Results In the 48 cases, there were 19 cases of pancreatic fistula （39.6%） , including 16 A-level cases and 3 B-level cases. Anastomotic contrast confirmed that there was no anastomotic leakage, which indicated that all cases were simple pancreatic fistula. The incidence of pancreatic fistula in the patients whose pancreatic texture （16/31, 51.6% ）was soft and brittle was significant higher than that of patients whose pancreatic texture was hard（3/17, 17.6%）. There was no reoperation cases or surgical deaths, All were cured by drainage. Conclusion After end to side penetrating-suture pancreaticojejunostomy, the incidence of pancreatic fistula is relatively high. All of them are simple pancreatic fistula, and the prognosis of them is good after drainage treatment.

关 键 词：胰十二指肠切除术 胰肠吻合 胰瘘 

分 类 号：R6[医药卫生—外科学]