胰十二指肠切除术48例临床分析

Clinical Analysis of Pancreatoduodenectomy in 48 Patients

目的探讨胰十二指肠切除术的临床疗效.方法回顾性分析昆明医学院第二附属医院2002年10月至2010年10月间行胰十二指肠切除术48例的临床病例资料.结果全组病例无手术死亡.术前接受减黄治疗16例,加行空肠造瘘术18例;术后病检胰头癌8例,胆总管下段癌7例,十二指肠乳头癌12例,壶腹周围癌10例,慢性胰腺炎5例,胆总管下段腺瘤2例,十二指肠管状腺瘤1例;术后胰漏3例,腹腔出血1例,消化道出血3例,胃瘫4例,术口裂开1例;统计学分析提示消化道重建方式与并发症的发生之间差异无统计学意义(P>0.05);应用空肠造瘘可缩短术后肠功能恢复时间及术后住院时间(P<0.05);合并糖尿病者术后胃瘫高发(P<0.05).结论围手术期的完善处理对于胰十二指肠切除术的疗效至关重要;不同消化道重建方式的术后并发症发生率无差别.附加空肠造瘘有利于患者术后恢复.合并糖尿病患者术后容易出现胃瘫.

Objective To investigate the clinical effect of pancreatoduodenectomy. Methods The clinical data of 48 patients who were performed pancreatoduodenectomy in our hospital from October 2002 to October 2010 were analysed retrospectively. Results There was no operative mortality in all cases. 16 patients were performed preoperative biliary drainage, and 18 patients were performed jejunostomy. Postoperative pathological examination：carcinoma of head of pancreas in 8 patients, distal common bile duct carcinoma in 7 patients, duodenal papilla carcinoma in 12 patients, periampallary carcinoma in 10 patients, chronic pancreatitis in 5 patients, distal common bile duct adenoma in 2 patients, duodenal papilla adenoma in 1 patient. Postoperative complications： pancreatic fistula in 3 patients, abdominal cavity bleeding in 1 patients, gastrointestinal bleeding in 3 patients, gastroplegia in 4 patients, disruption of wound in I patient. There was no statistically significant difference in postoperative complications among different digestive tract reconstruction methods （P 〉 0.05 ）. There was statistically significant difference in postoperative intestinal function recovery time and hospital stay between performed jejunostomy and not （P 〈 0.05）. There was statistically significant difference in postoperative gastroplegia between complicated diabetes and not （P 〈 0.05）. Conclusions The complete perioperative treatment is very important to the effect of pancreaticoduodenedtomy. There is no significant difference in postoperative complications among different digestive tract reconstruction methods. Jejunostomy is beneficial to postoperative recover of patients. The patients with complicated diabetes liable to gastroplegia.