恶性肿瘤病人胰十二指肠切除术后胰瘘及胆瘘的防治

Protection and Treatment for Pancreatic Fistula and Choledochus Fistula After Pancreaticoduodenectomy

目的 总结恶性肿瘤病人胰十二指肠切除术（PD）主要并发症胰瘘、胆瘘的初步处理经验和体会，并探讨其防治措施。方法 对1998年1月至2003年1月间的20例PD术后并发胰瘘、胆瘘病例进行回顾性分析。结果 全组病例手术均获得成功。术后并发胰瘘2例，死亡1例；并发胆瘘2例，死亡1例；另1例死于肝肾综合症，余17例治愈出院。远期效果在进一步随访中。结论 术后并发胰瘘应以内科治疗为主，通过减少胰液的分泌，并且保持局部引流的通畅，多数胰瘘可治愈。术后并发胆漏，通过保持支架管及局部引流通畅，多可治愈，出现肝汁性腹膜炎时应考虑手术处理。

Objective To explore the protection and treatment for pancreatic fistula and bile fistula after pancreaticoduodenectomy. Methods A retrospective study was conducted to analyze 20 patients with pancreatic fistula and bile fistula from January 1998 to January 2003. Results Among 20 patients, 2 patients had pancreatic fistula and 1 case died of pancreatic fistula. 2 patients had bile fistula and 1 case died of bile fistula. 1 patient died of hepatorenal syndrome. Conclusions Patients with pancreatic fistula ought to be medical treat mostly, reduce exudation of pancreatic juice, and keep checklees of drainage. Patients with bile fistula ought to keep checklees of drainage. Operation should be adopted for the patients of choleperitonitis.