早期持续负压引流在胰十二指肠切除术后胰瘘高危患者中的作用  

Early persistent vacuum suction drainage in patients with high risk of pancreatic fistula after pancreaticoduodenectomy

作　　者：陈华[1] 张广权[1] 李轶龙[1] 李国庆[1] 孔瑞[1] 白雪巍[1] 王拥卫[1] 谭宏涛[1] 王刚[1] 孙备[1] Chen Hua Zhang Guangquan Li Yilong Li Guoqing Kong Rui Bai Xuewei Wang Yongwei Tan Hongtao Wang Gang Sun Bei(Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China)

机构地区：[1]哈尔滨医科大学附属第一医院胰胆外科,150001

出　　处：《中华内分泌外科杂志》2016年第6期446-450,共5页Chinese Journal of Endocrine Surgery

基　　金：国家自然科学基金（81302057）,黑龙江省青年科学基金项目（QC2012C042）

摘　　要：目的探讨在胰十二指肠切除术（pancreaticoduodenctomy，PD术）后胰瘘高危患者中施行早期持续负压引流对预防、治疗术后胰瘘的作用。方法回顾性分析2010年7月至2013年6月间行PD术的286例患者的临床资料，筛选出术后胰瘘高危患者87例，根据术后引流管处理方式将其分为术后早期持续负压引流组（观察组）和常规引流组（对照组），对2组患者的一般资料、术中出血量及手术时间、胰瘘等术后并发症发生率及死亡率、医疗费用及住院时间等进行统计分析。结果观察组共计40例。对照组共计47例，2组患者在临床基本资料与手术基本资料方面差异均无统计学意义。2组间术后总体胰瘘发生率、胃瘫、胆瘘、出血及切口感染发生率无差别，但观察组B、C级胰瘘的发生率显著低于对照组（12．5％vs34．0％，P〈0．05），腹腔感染发生率低于对照组（20．0％vs40．4％，P〈0．05），差异有统计学意义。2组间总体并发症发生率观察组显著低于对照组（60．0％vs83．0％，P〈0．05），但2组间死亡率无差别；术后早期持续负压引流能降低PD术后胰瘘高危患者的平均住院时间（（21．93±7．14）vs（28．70±12．45）d,P〈0．05）及临床花费（（6．48±1．20）vs（7．52±1．46）万元，P〈0．05）。结论在PD术后胰瘘高危患者中，术后早期持续负压引流降低了PD术后胰瘘高危患者中B、C级胰瘘、腹腔感染的发生率和总体并发症的发生率，加速了患者术后的恢复，降低了患者的住院花费,值得广泛应用。Objective To study the function of early persistent vacuum suction drainage in patients with high risk of pancreatic fistula after pancreaticoduodeneetomy （PD）. Methods From Jul. 2010 to Jun. 2013, the clinical data of 286 patients undergoing PD were retrospectively evaluated. 87 patients with high risk of pancreatic fistula were screened and then divided into early persistent vacuum suction drainage group （the observation group） and conventional drainage group （the control group） according to postoperative drainage manners. We statistically analyzed the two groups in terms of general information, blood loss, operative time, medical expenses, hospital stay, mortality and morbidity of complications such as pancreatic fistula. Results There were 40 patients screened into the observation group and 47 patients into the control group. No difference was found between the observation group and the control group in basic clinical data or surgical data. There was no statistical difference between the two groups in delayed gastric emptying, bile leakage, bleeding or the incidence of pancreatic fistula and intra-abdominal infection. The incidence of pancreatic fistula with grade B and C in the observa- tion group was statistically lower than that of the control group（ 12.5% vs 34.0%, P〈0.05 ）. The incidence of intraabdominal infection in observation group was statistically lower than those in the control group （20.0% vs 40.4%, P〈0.05）. The incidence of total complications in observation group was statistically lower than that in the control group （60.0% vs 83.0%, P〈0.05）, but no difference was found between the observation group and control group in morality. Early persistent vacuum suction drainage could reduce hospital stay（（21.93±7.14） days vs （28.70±12.45） days, P〈0.05） and clinical expense （（64.8±12.0） thousands vs （75.2± 14.6） thousands, P〈0.05） in patients with high risk of pancreatic fistula after PD. Conclusions Early persistent vacuum suction drainage c

关 键 词：胰十二指肠切除术 胰瘘 引流 

分 类 号：R656[医药卫生—外科学]