胰十二指肠切除术后胰瘘的防治体会

Pancreatic fistula after pancreaticoduodenectomy

目的分析胰十二指肠切除术后胰瘘的防治措施,以减少胰十二指肠切除术后并发症发生率。方法2001年1月至2005年12月对106例患者行胰十二指肠切除术,其中常规胰十二指肠切除术87例,保留幽门的胰十二指肠切除术4例,扩大胰十二指肠切除术15例。结果术后共出现胰瘘11例(10.4%),胰腺空肠端端套入式吻合、胰腺空肠端侧套入式吻合、胰管空肠黏膜吻合三种吻合方式胰瘘发生率分别为9.6%、12.9%和8.7%。术后平均胰瘘持续时间为(14.7±4.5)d。所有胰瘘患者均应用生长抑素类药物抑制胰腺外分泌治疗。结论防治胰十二指肠切除术后胰瘘的关键是改善胰肠吻合口的质量和保持引流通畅。术后应用生长抑素类药物有助于胰瘘的愈合。

Objective To investigate the therapies for pancreatic fistula after pancreaticoduodenectomy and decrease its morbidity. Methods Retrospective analysis were made in 106 cases undergoing pancreaticoduodenectomy from January 2001 to December 2005 in our hospital. Results Eightyseven cases accepted PD,4 cases for PPPD and 15 cases for extended PD. Pancreatic fistula rate was 10.4 % （ 11/106）. The fistula rate was 9.6 % , 12.9 % , and 8.7 % respeetively for end - to - end invaginated pancreaticojejunostomy,end to side invaginated pancreaticojejunostomy and duct - to - mu cosa pancreaticojejunostomy. The fistula was last for （ 14.7 ± 4.5 ）days medially. All patients with pancreatic fistula were treated with Octreotide. Conclusion The safety of pancreaticoduodenectomy and keeping the drainage unobstructed are the most important factors and somatostatin is helpful for pancreatic fistula.