胰十二指肠切除术后胰肠吻合口源性早期出血分析  

Analysis of early hemorrhage from pancreaticojejunal anastomosis after pancreaticoduodenectomy

作　　者：李尚胜 李鹏 丁建华 孙文兵[2] 王向涛 Li Shangsheng;Li Peng;Ding Jianhua;Sun Wenbing;Wang Xiangtao(Department of Hepatobiliary-Pancreatic-Splenic Surgery,Binzhou Second People's Hospital,Binzhou 256800,China;Department of Hepatobiliary-Pancreatic-Splenic Surgery,Shijingshan Campus,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100043,China)

机构地区：[1]滨州市第二人民医院肝胆胰脾外科,滨州256800 [2]首都医科大学附属北京朝阳医院石景山院区肝胆胰脾外科,北京100043

出　　处：《国际外科学杂志》2023年第6期394-396,I0005,共4页International Journal of Surgery

基　　金：肾脏疾病发生与干预湖北省重点实验室开放基金(SB202115)。

摘　　要：目的探讨胰十二指肠切除术(PD)后胰肠吻合口源性术后早期出血(EPOH)的治疗体会。方法回顾性收集滨州市第二人民医院收治的1例PD后胰肠吻合口源性EPOH患者的病例资料,分析EPOH发生的主要原因和治疗方法。结果由于胰管纤细等原因,术中2次离断胰腺均未能找见胰管,为预防胰液引流不畅及其相关并发症,未对残胰断面进行有效缝扎,吻合方式采用垂直褥式缝合。患者术后当天即发生重度EPOH,由于患者采用的消化道重建方式为胆胰分离式,得以通过影像和内镜明确诊断为胰肠吻合口源性EPOH,经积极的内科治疗后痊愈出院。结论对于PD后残胰断端的处理,在确保胰管引流通畅的前提下,应对残胰断端进行确切缝合,以最大程度地避免胰肠吻合口源性EPOH。Objective To explore the therapeutic experience of early postoperative hemorrhage(EPOH)from pancreaticojejunal anastomosis after pancreaticoduodenectomy(PD).Methods A retrospective review was conducted to summarize the clinical data of a typical case of EPOH from pancreaticojejunal anastomosis after PD in Binzhou Second People's Hospital,and the main causes and treatment of EPOH were analyzed.Results Due to reasons such as the slender pancreatic duct,the pancreatic duct was not found after twice transections of the pancreas during the surgery.To prevent poor pancreatic fluid drainage and related complications,the pancreatic stump was not effectively sutured,and a vertical mattress suture method was used for the pancreaticojejunal anastomosis.The patient developed severe EPOH on the surgery day.Due to the fact that the digestive tract reconstruction was a biliary pancreatic separation method,the cause of EPOH was diagnosed from pancreaticojejunal anastomosis through imaging and endoscopy.After active medical treatment,the patient recovered and was discharged.Conclusion For the treatment of pancreatic stump after PD,precise suturing should be performed on the stump while ensuring smooth pancreatic duct drainage,in order to avoid EPOH from pancreaticojejunal anastomosis to the greatest extent possible.

关 键 词：胰十二指肠切除术 早期诊断 手术后出血 胰肠吻合口 胰肠吻合术 消化道重建 

分 类 号：R657.5[医药卫生—外科学]