胰体尾切除术后胰瘘的因素及防治  

Risk factors, prevention and treatment of pancreatic fistula after distal pancreatectomy

作　　者：张东欣 许英晨[1] 张立军[1] 栗光明[1,2] ZHANG Dong-xin;XU Ying-chen;ZHANG Li-jun;LI Guang-ming(Department of General Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;General Surgery Center,Beijing Youan Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京同仁医院普外科,北京100730 [2]首都医科大学附属北京佑安医院普通外科中心,北京100069

出　　处：《中国现代普通外科进展》2022年第5期367-370,共4页Chinese Journal of Current Advances in General Surgery

基　　金：首都医科大学附属北京同仁医院院内基金(TRYY-KYJJ-2016-049);首都卫生发展科研专项(首发2016-2-2053)。

摘　　要：目的:探讨胰体尾切除术后胰瘘发生的相关因素及防治。方法:回顾性分析2014年4月—2019年4月49例行胰体尾切除术患者的临床资料,包括术前基本资料、术中操作及术后治疗等资料,并对其进行分析。结果:术后共有12例患者出现并发症,占24.5%(12/49)。其中胰瘘发生率为22.4%(11/49),B级胰瘘10例(20.4%),经保守治疗后痊愈;C级胰瘘1例(2.0%),二次手术后痊愈。年龄、性别、BMI、有无糖尿病、是否联合脾切除、病变性质、术中出血、手术时间等与是否发生胰瘘无相关性(P>0.05),但胰瘘会增加患者术后住院时间(P<0.05)。无死亡病例。结论:胰瘘仍是胰体尾切除术后最常见的并发症;术中胰腺断端的处理及围手术期的管理是预防胰体尾切除术后胰瘘的关键;通畅引流、腹腔冲洗以避免局部胰液积聚是胰瘘治疗的基本原则,并需要积极寻找新的治疗方法。Objective:To explore the related factors,preventions and treatments of pancreatic fistula after distal pancreatectomy.Methods:The clinical data of 49 patients undergoing distal pancreatectomy from April 2014 to April 2019 were retrospectively analyzed,including basic information before,during and after surgery.Results:Postoperative complications occurred in 12 patients and the morbidity was 24.5%.The incidence of pancreatic fistula was 22.4%(11/49).Ten cases(20.4%)of grade B pancreatic fistula were cured after conservative treatment,and 1 case(2.0%)of grade C pancreatic fistula was cured after reoperation.The factors including age,gender,BMI,preoperative diabetes,combined splenectomy,pathology,intraoperative blood loss and operation time were not related to the incidence of pancreatic fistula(P>0.05),but pancreatic fistula prolonged the postoperative hospital stay(P<0.05).There were no deaths.Conclusions:Pancreatic fistula is still the most common complication after distal pancreatectomy.The management for the pancreatic stump and the perioperative management are the keys to prevent pancreatic fistula.The treatment of pancreatic fistula lies in unobstructed drainage,strengthening nutrition support,and it is necessary to actively seek new ones treatment method.

关 键 词：胰体尾切除术 胰瘘 术后并发症 

分 类 号：R657.5[医药卫生—外科学] R619[医药卫生—临床医学]