生长抑素预防胰十二指肠切除术后并发症的应用体会

APPLICATION OF SOMATOSTATIN FOR THE PREVENTION OF COMPLICATIONS FOLLOWING PANCREATODUODENECTOMY

目的探讨生长抑素(思他宁)在胰十二指肠切除术后并发症预防的临床应用价值。方法回顾分析我院2005年1月至2010年6月共收治的因壶腹部肿瘤和胰头癌行胰十二指肠切除术患者40例,其中14例术后预防性应用了生长抑素(思他宁),余26例为同期对照组即术后没有预防性应用生长抑素,全组病例术后常规肠外营养及抗生素治疗,比较两组的术后消化液分泌量、并发症的发生率及术后平均住院日。结果在术后7天内,思他宁组胰液平均(45.87±33.48)ml,胃液平均(179.97±61.64)ml,对照组胰液平均(68.89±34.00)ml,胃液平均(227.00±72.23)ml,前者各消化液的引流量较对照组显著减少(P<0.05);所有病例中,胰漏3例,出血1例,胆漏1例,胃排空延迟2例,腹腔感染1例,切口感染2例,其他并发症0例,死亡1例,两组总并发症发生率无明显差异(P>0.05);思他宁组术后住院天数(30±14)天,对照组(28±11)天,是否预防性应用生长抑素并没有影响术后住院天数(P>0.05)。结论生长抑素在胰十二指肠切除术术后抑制各消化液的分泌方面起着重要的作用,但是对于胰十二指肠切除术术后并发症的预防,术后住院天数等方面并无显著影响,因此生长抑素(思他宁)在PD术后常规预防性应用并非十分必要。

Objective To assess the effectiveness of somatostatin in preventing postoperative complications following pancreatoduodenectomy.Methods The clinical data 40 cases of pancreatoduodenectomy for Pancreatic head carcinoma or Pot belly surrounding cancer performed from January 2005 to June 2010 were retrospectively analyzed.They were divided into Somatostatin group（n=14）and control group（n=26）.All the cases were given regular parenteral nutrition and antibiotics.The daily digestive juice output,the complications and postoperative average hospital stay were analyzed.Resuts Within 7 days after surgery,in Somatostatin group average pancreatic juice of（45.87±33.48） ml and average gastric juice（179.97±61.64） ml vs of（68.89±34.00） ml,（227.00±72.23） ml in the control group,the former each digestive juices significantly reduced（P0.05）.All cases,3 cases of pancreatic leakage,1 case of hemorrhage,2 case with delayed gastric emptying,celiac infection in 2 cases,infection of incision in 2 cases,the death in 1 case;the incidence of total complication did not show obvious differences（P0.05）.In Somatostatin group average postoperative hospital stay（30±14） days vs（28±11） days in the control group（P0.05）.Conclusion Prophylyication use of somatoatain does not reduce the incidence of total complication rate,hospital stay after pancreaticoduodenectomy.So the routine use of somatoatain after pancreaticoduodenectomy should not be necessary.