胰十二指肠切除术的围手术期处理:附324例分析

The perioperative management for pancreaticoduodenectomy:an analysis of 324 cases

目的总结324例胰十二指肠切除术(PD)患者围手术期的处理经验,以提高该术式的治愈率,降低并发症发生率。方法回顾性分析324例行PD患者的临床资料,全组均成功实施胰头十二指肠切除术,275例行PD,49例行保留幽门式胰十二指肠切除术(PPPD)。消化道重建均采用Child法;胰肠吻合方式303例为胰肠端端套入式吻合,21例为端侧吻合。.结果术后并发症发生率为8.0%(26/324):肝功能不全1例,胰瘘伴腹腔出血7例,1例胰管狭窄,胰腺外分泌功能不良者3例,吻合口溃疡4例,胃排空障碍6例,胆肠反流1例,淋巴瘘3例。术后30 d死亡内死亡1例。结论胰十二指肠切除术围手术期的管理对患者的预后至关重要。细心的围手术期管理,对减少术后并发症,保证患者顺利康复意义重大。

Objective To review the experience in perioperalive management of 324 consecutive cases of pancreatico-duodenectomy （PD）. Methods The clinical data of 324 cases of PD were analyzed retrospectively. All underwent PD successfully, 275 cases received the standard PD, while, 49 cases had pylorus preserving PD. Digestive tract reconstruction was done by Child method. Pancreatointestinal anastomosis was performed by pancreas stump intussussception in 303 cases, and end-to-side anastomosis in 21 cases. Results The 30 day mortality rate was 0. 3% （ 1/324 ）. Complicalion rate was 8. 0% , included one case of liver dysfunction, 7 cases with pancreatic fistula and intraabdomind bleeding, 1 case of stenosis of pancreaticoenteral anastomosis, 3 eases with pancreatic dysfunction, 4 cases with gastroenteral anastomosis ulcer, 6 cases with delayed gastric emptying, 1 with reflux of bile and 3 with lymphatic fistula. Conclusions Perioperative managemen for pancreaticoduodenectomy is crucial for patient prognosis. Carful perioperative management can decrease postoperative complications and ensure smooth recover of these patients.