胰十二指肠切除术后胰瘘的预防(附63例报告)(英文)

Precaution of pancreatic fistula after pancreaticoduodenectomy (report of 63 cases)

目的探讨胰十二指肠切除术(PD)后胰瘘的预防措施。方法对63例病人的治疗过程进行回顾性分析。根据作者的经验结合国内外文献,对PD术式的选择、术后胰瘘的最常见原因以及预防措施进行充分讨论。结果该组病例中,62例治愈,1例死于术中广泛渗血。存活者术后均无胰瘘的发生,也无腹腔内感染和切口裂开。术后随访:2例病人由于胆肠吻合口狭窄而反复出现感染症状,经二次Roux-Y内引流术治愈;3例出现不完全性肠梗阻,通过保守治疗治愈。结论良好的术前准备、熟练的手术技巧和适宜的术后处理对预防遗漏的发生非常重要的。

[Objective] To study precautionary measure of pancreatic fistula after paneretieo duodeneetomy （PD）. [Methods] Therapeutic course of 63 patients was retrospectively analysed. On the basis of author＇s experience and domestic and foreign literature, choice of operative mode, the common cause and precautionary measure of pancreatic fistula were completely discussed. [Results] In this group, 62 eases were cured, one ease died from extensive oozing blood in operation. There was no pancreatic fistula happened after operation, there was no irffeetion of abdominal cavity or dehiscence of incision. Follow-up： infection oeeured again and again in two eases due to stenosis of eholangiojejunum anastomosis, who were cured by the second internal drainage of Roux-Y type. 3 eases suffered from incomplete intestinal obstruction, which were cured by conservative treatment. [ Conclusions] Good preoperative preparation, skilled operative technique and proper postoperative management can prevent pancreatic or biliary fistula after PD.