胰十二指肠切除术后肝梗死、肝脓肿发病原因及诊治研究  

Diagnosis,treatment and etiology of hepatic infarction and abscess after pancreaticoduodenal surgery

作　　者：徐强[1] 戴梦华[1] 赵玉沛[1] XU Qiang;DAI Meng-hua;ZHAO Yu-pei(Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medial Sciences, Beijing 100730, China)

机构地区：[1]中国医学科学院北京协和医院基本外科

出　　处：《中国实用外科杂志》2019年第6期599-605,共7页Chinese Journal of Practical Surgery

摘　　要：目的探讨胰十二指肠切除术(PD)后肝梗死、肝脓肿病因及治疗方法。方法回顾性分析中国医学科学院北京协和医院2012年1月至2018年12月期间PD术后诊断为肝梗死、肝脓肿的病例,分析其病因及治疗。结果共11例病人术后明确诊断肝梗死、肝脓肿,其中3例在围手术期死亡,6例出现胆漏。7例明确合并肝固有动脉、副右肝动脉的截断或狭窄,1例术前存在腹腔干根部狭窄,3例存在门静脉狭窄。肠球菌、克雷伯菌是比较常见的致病菌,真菌作为致病菌较为常见。抗感染及介入治疗是主要的治疗手段。结论 PD后肝动脉、门静脉的缺血是发生肝梗死、肝脓肿的主要原因,常合并胆漏及多重致病菌的感染,病死率较高。Objective To explore the causes and treatment of hepatic infarction and abscessafter pancreaticoduodenal surgery.Methods The clinical data of 11 cases of hepatic infarction or abscess after pancreaticoduodenal surgery in Peking Union Medical College Hospital between January 2012 and December 2018 were analyzed retrospectively.Results A total of 11 patients were diagnosed of hepatic infarction or abscess after PD.The overall mortality rate was27.3%(3 of 11 patients).54.5%(6/11)had biliary fistula.Of the 11 patients,7 had proper hepatic artery and right accessory hepatic artery occlusion or stenosis,1 had abdominal trunk root stenosis before operation,and 3 had PV stenosis.Enterococcus and Klebsiella were the organisms most frequently cultured,and fungi were also the common pathogens.Antibiotics and selective percutaneous drainage were the main means of treatment.Conclusion Ischemia of hepatic artery and portal vein after PD is the main cause of liver infarction and liver abscess.Biliary fistula and multiple pathogenic bacteria are often associated with high mortality.

关 键 词：胰十二指肠切除术 肝梗死 肝脓肿 肝动脉损伤 

分 类 号：R6[医药卫生—外科学]