胆胰术后胰瘘的非手术引流

THE MANAGEMENT OF POSTOPERATIVE PANCREATIC FISTULAS BY ENDOSCOPIC NASOPANCREATIC DUCT DRAINAGE

用内镜鼻胰管（ＥＮＰＤ）负压引流方法治疗５例术后胰瘘患者获得满意效果。经保守治疗９０～７２０天未愈病人，在内镜治疗后瘘道引流即刻显著减少５０％ ，在１２～２８天瘘道闭合。作者认为内镜治疗的目的是减除胰管梗阻和压力，把胆汁和胰液引流到１２指肠和体外以促进瘘道封闭。有保留Ｏｄｄｉ’ｓ扩约肌生理功能，造影显示胰管解剖和胰瘘部位，效果确切安全并发症少、避免再次手术，负压吸引促进瘘道闭合，明显缩短住院时间和降低医疗费用等优点。

The authors management of 5 patients with postoperative pancreatic fistulas by endscopic nasopancretic duct drainage had got a satisfactory effect.12～28 day after of treatment,the leakage was decreased,the fistulas were closed .The patients with conservative treatment were not yet recovered after 90～720 day .The author thought that the purpose was reducing the pressure of pancreatic duct to let pancreatic liquid flawing into the duodenum and extrabody that promoted leakage stopped.The advantages of endoscopic nasopancreatic duct drainage are as followes:a.Retain the function of the Oddi''s sphincter.b.Can show clearly anatomy of the pancreatic duct and the position of pancreatic fistulas with pancreaticography. The drain effects are certain, safe and less complicating,avoiding reoperation.d.Can promote the leakage stop with the drainage of negative pressure aspiration,ie.shortening the times in hospital and reduce medicinal fee obviously.