主胰管导管桥式内引流术救治胰肠吻合口裂开

The treatment of the fissuration of pancreatojejunal stoma by the bridge-crossing internal drainage

目的探讨胰头十二指肠切除术后胰肠吻合口裂开胰漏并引起腹腔大出血的外科治疗方法。方法3例行胰头十二指肠切除术后发生胰肠吻合口破裂、严重胰漏伴腹腔大出血均急诊再次手术治疗，术中借用主胰管置管并将胰液引流到临近的空肠袢内。结果术后经支持治疗，持续腹腔冲洗，抑制胰酶分泌，治疗成功。结论主胰管导管桥式内引流术，在胰头十二指肠切除术后胰肠吻合口裂开胰漏导致的腹腔大出血抢救治疗中具有简单快捷有效的治疗效果，挽救了患者的生命，保存了胰腺功能，改善了术后生活质量。

Objective The purpose of this study was to discuss the therapies for hemorrage caused by the fissuration of pancreatojejunal stoma and pancreatic leakage after pancreatoduodenectomy. Methods After three cases of pancreatoduodenectomy, the disruptions of pancreatojejunal stoma resulted in serious pancreatic leakage and the hemorrage in abdominal cavity. During all the second operations, the drainage-tube insertions in- to the main pancreatic ducts were used to lead the pancreatic juice into the neighboring loop of jejunum. Results Afer the operations, the supportive treatment, continuous irrigation of peritoneal cavity and pancreatic enzyme inhabition were given to the patients of these cases and all of the patients were successfully cured. Conclusions The bridge-crossing internal drainage which inserts drainage-tube into the main pancreatic duct was a convenient and effective therapy and method to rescue the hemorrage caused by the fissuration of pancreatojejunal stoma and pancreatic leakage after pancreatoduodenectomy. While the patients＇ lives were saved, their functions of pancreas were preserved and the qualities of life were improved after the operations.