胰体尾切除术后胰瘘预防及处理  

Prevention and treatment for pancreatic fistula after distal pancreatectomy

作　　者：杨明[1] 王春友[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院胰腺外科,湖北武汉430022

出　　处：《中国实用外科杂志》2015年第8期834-838,共5页Chinese Journal of Practical Surgery

摘　　要：胰体尾切除术术后胰瘘发生率较高,主要与胰腺质地、胰管直径及胰腺残端的处理方式等有关。依据胰腺质地及病理检查结果合理选择胰腺残端处理方式是减少胰瘘发生的关键。胰腺肥厚或水肿质脆者胰瘘发生率较高,推荐残端手工缝合;如近端胰管存在梗阻并伴胰管扩张,建议行胰管-空肠吻合;对于胰腺扁平且质地柔软者,推荐使用直线切割闭合器。胰体尾切除术术后胰瘘经非手术治疗多可治愈。通畅引流可有效预防腹腔感染和出血的发生,是促进胰瘘愈合的关键。非手术治疗无效时可考虑胰管支架置入,部分难治性胰瘘病人须行窦道-空肠吻合。The incidence of pancreatic fistula after distal pancreatectomy is higher. Some of the main risk factors associated with pancreatic fistula after distal pancreatectomy include soft pancreatic texture, smaller pancreatic duct diameter and the handling of the pancreatic stump. Surgical techniques should been selected reasonably according to the pancreas texture and pathology, which is the key to decrease the incidence of pancreatic fistula. The optimal surgical method for a thick or edema pancreas is still a standardized hand-sewn closure technique of the pancreatic remnant. An anastomosis of the remnant to the intestine should be considered to prevent pancreatic fistula in the case of proximal duct obstruction associated with dilatation of the main pancreatic duct. The stapler technique should be recommended as the preferred method of pancreatic stump closure for a soft and flat pancreas. Most cases of pancreatic fistula could be cured by conservative treatment. Effective drainage plays an important role in the management of pancreatic fistula and in prevention of abdominal infection and bleeding. Pancreatic stent placement should be considered on the principle of failure of conservative treatment. Some of cases need fistulojejunostomy for refractory pancreatic fistulas.

关 键 词：胰体尾切除术 胰瘘 

分 类 号：R6[医药卫生—外科学]