全胰腺切除术治疗Whipple术后胰腺断端出血  

Total pancreatectomy for pancreatic cut end hemorrhage after Whipple procedure

作　　者：熊志勇[1] 徐见亮[2] 姚志成[1] 胡昆鹏[1] 李瑞曦[2] 方和平[2] 邓美海[2] 

机构地区：[1]中山大学附属第三医院岭南医院普通外科,广州510530 [2]中山大学附属第三医院肝胆外科,广州510630

出　　处：《中华肝脏外科手术学电子杂志》2017年第3期177-180,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省自然科学基金(S2013010016015);广州市科技计划项目(2013J4100061)

摘　　要：目的探讨全胰腺切除术在治疗Whipple术后胰腺断端出血的安全性和应用价值。方法回顾性分析2013年11月中山大学附属第三医院收治的1例行全胰腺切除术治疗Whipple术后胰腺断端出血的胆管癌患者临床资料。患者因"尿黄3周、身目黄染伴皮肤瘙痒2周"入院。腹部超声、MRI及超声内镜检查均提示壶腹部占位性病变。观察患者的发病情况、诊断、治疗及疗效。患者已签署知情同意书,符合医学伦理学规定。结果患者气管插管全身麻醉后,行Whipple术。术后胰腺断端出血,多次行再次手术及介入栓塞无效后行全胰腺切除术,病理检查诊断为胆囊癌。术后予胰酶制剂、胰岛素治疗后痊愈。术后患者生存良好,未见复发。结论全胰腺切除术可考虑作为Whipple术后严重并发症处理的选择之一。Objective To investigate the safety and application value of total pancreatectomy for pancreatic cut end hemorrhage after Whipple procedure. Methods Clinical data of 1 patient with cholangiocarcinoma who underwent total pancreatectomy for treating the pancreatic cut end hemorrhage after Whipple procedure in the Third Affiliated Hospital of Sun Yat-sen University in November 2013 were retrospectively analyzed. The patient was admitted to hospital due to yellow urine for 3 weeks, and yellow sclera and skin accompanied with cutaneous pruritus for 2 weeks. Space- occupying lesions in the ampulla were found by abdominal ultrasound, MRI and ultrasonic endoscope examination. The pathogenesis, diagnosis, treatment and clinical efficacy of the patient were observed. The informed consents of the patient was obtained and the local ethical committee approval was received. Results The patient underwent Whipple procedure under general anesthesia by tracheal intubation. Pancreatic cut end hemorrhage after surgery was observed and had no effects to repeated reoperation and interventional embolization therapy. Eventually, total pancreatectomy was performed. The patient was diagnosed with gallbladder carcinoma by pathological examination. The patient healed after postoperative administration of pancreatin and insulin. The patient survived well after surgery and no recurrence was observed. Conclusion Total pancreatectomy can be considered as one of the options for treating the severe postoperative complications alter WhippLe procedure.

关 键 词：胰腺切除术 胰十二指肠切除术 胆管肿瘤 出血 

分 类 号：R735.8[医药卫生—肿瘤]