不同胰管内置管引流方式在胰十二指肠切除术中的应用效果  

Clinical effects of different pancreatic duct drainage in pancreaticoduodenectomy

作　　者：赵明勋[1] 张文智[2] 冷建军[2] 

机构地区：[1]吉林省图们市人民医院外科,吉林图们133100 [2]解放军总医院肝胆外科,北京100853

出　　处：《中国当代医药》2016年第23期25-27,共3页China Modern Medicine

摘　　要：目的分析胰十二指肠切除术（pancreaticoduodenectomy,PD）中胰管内置管内、外引流方式与术后胰瘘、胆漏、腹腔出血、腹腔感染等并发症发生的关系,并探讨发生胰瘘后的处理方法。方法选取2013年5月~2015年1月在解放军总医院行PD术中胰管内放置引流管引流的81例患者作为研究对象,根据胰管引流方式的不同分为A组（49例）和B组（32例）,A组采用胰管内置管内引流方法 ,B组采用胰管内置管外引流方法 ,比较两组术后胰瘘、胆漏、腹腔出血、胃瘫、腹腔感染、切口并发症和乳糜漏等并发症发生率。结果 A组的手术时间显著短于B组,差异有统计学意义（P〈0.05）。两组的术前谷丙转氨酶、总胆红素、白蛋白水平及术中失血量比较,差异无统计学意义（P〉0.05）。A组术后胰瘘、胆漏、腹腔出血、腹腔感染等各种并发症发生率与B组比较,差异无统计学意义（P〉0.05）。结论胰管内引流方式较胰管外引流更简便,节省手术时间。术中细致的操作和术后充分的引流是降低术后并发症发生率、死亡率,安全度过围术期的关键所在。Objective To analyze the correlations of different pancreatic duct drainage（external vs internal） with postoperative complications including pancreatic fistula,biliary fistula,intraperitoneal hemorrhage and infection,and explore treatment strategy for pancreatic fistula.Methods 81 cases who received pancreatic duct drainage in pancreaticoduodenectomy in the General Hospital of PLA from May 2013 to January 2015 were selected and divided into group A（n=49） and group B（n=32）,receiving internal and external drainage respectively.The rates of complications were compared including pancreatic fistula,biliary fistula,intraperitoneal hemorrhage,gastroplegia,infection,incision complications and chylous fistula etc.Results The time of operation in group A was shorter than that in group B with statistical significance（P〈0.05）.The levels of alanine transaminase,total bilirubin and albumin before surgery,as well as intraoperative blood loss between two groups showed no significant differences（P〉0.05）.The rates of postoperative complications including pancreatic fistula,biliary fistula,intraperitoneal hemorrhage and infection in group A were not significantly different from those in group B（P 〉0.05）.Conclusion Internal pancreatic duct drainage is simpler and spends less time than that of external drainage.Careful operation and complete drainage after opration are essential for reducing the rates of postoperative complication and death rate,safely spenting perioperation.

关 键 词：胰十二指肠切除术 胰管引流 胰瘘 

分 类 号：R657.5[医药卫生—外科学]