腹腔镜胰十二指肠切除术后再手术十例分析  

Reoperation after laparoscopic pancreatoduodenectomy: an analysis of ten patients

作　　者：段小辉[1] 刘小梯 吴浩然 周力学[1] 田秉璋[1] 杨建辉[1] 李霞[1] 蒋波[1] 毛先海[1] Duan Xiaohui;Liu Xiaoti;Wu haoran;Zhou Lixue;Tian Bingzhang;Yang Jianhui;Li Xia;Jiang Bo;Mao Xianhai(Department of Hepatobiliary Surgery(Research Laboratory of Hepatobiliary Tumor),Hunan Provincial People's Hospital,First Affiliated Hospital of Hunan Normal University,Changsha 410005,China)

机构地区：[1]湖南省人民医院湖南师范大学附属第一医院肝胆外科(肝胆肿瘤研究室),长沙410005

出　　处：《中华肝胆外科杂志》2019年第2期102-105,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：湖南省教育厅科学研究重点项目(16A127);湖南省科技计划重点研发项目(2015sk2050).

摘　　要：目的探讨腹腔镜胰十二指肠切除(LPD)术后再手术的原因及对策。方法回顾湖南省人民医院2014年4月至2018年4月施行的250例LPD患者临床资料,分析10例患者(4.0%,10/250)因各种并发症再次手术的原因、手术方式及疗效。结果再手术原因包括腹腔内出血7例(其中2例合并胰瘘,1例合并胆胰瘘),胃肠吻合口输出袢穿孔1例,腹腔脓肿1例,术后胰腺炎1例。再次时间为首次手术后第1至82天。再手术方式主要包括缝扎止血、消化道重建、消化道造瘘及腹腔引流。10例再手术患者有2例(20.0%)死亡。结论腹腔镜胰十二指肠切除术后再手术主要原因是并发腹腔出血、胰瘘、腹腔脓肿等。及时果断的再手术是处理腹腔镜胰十二指肠切除术后严重并发症及降低患者病死率的有效手段。Objective To investigate the causes and countermeasures of reoperation following laparoscopic pancreatoduodenectomy. Methods The causes, approaches and outcome of reoperation were retrospectively analyzed in 10(4.0%, 10/250) patients undergoing reoperations following pancreaticoduodenectomy with various complications in Hunan Provincial People’s Hospital from April 2014 to April 2018. Results The causes of the 10 patients including intra-abdominal bleeding of seven cases (2 cases combined with pancreatic fistula, 1 case with pancreatic and biliary fistula), 1 patient with gastrointestinal anastomosis output perforation, 1 patient with intra-abdominal abscess, and 1 case with postoperative pancreatitis. The time of reoperation was one day to 82 day after the first operation. The main methods of reoperation including suture and hemostasis, rebuilding the digestive tract, gastrostomy and enterostomy combined with abdominal cavity drainage. The mortality of reoperation following laparoscopic pancreatoduodenectomy was 20.0%(2/10). Conclusions Intra-abdominal hemorrhage, pancreatic fistula and intra-abdominal abscess are the major causes of reoperation after laparoscopic pancreatoduodenectomy. Timely and decisive reoperation is an effective means to reduce postoperative morbidity and mortality after LPD.

关 键 词：胰十二指肠切除术 腹腔镜 手术后并发症 再手术 病死率 

分 类 号：R657.5[医药卫生—外科学]