急诊胰十二指肠切除术后并发胆胰漏的处理

Pancreatic and biliary drainage for the treatment of bile leakage and severe intra-abdominal infection after pancreatiduodenectomy due to severe trauma

目的探讨因腹部外伤行急诊胰十二指肠切除术（pancreaticoduodenectomy，PD）后胆胰漏的发生及并发严重腹腔感染需再次手术时的处理策略。方法回顾分析10年来因腹部外伤而急诊行PD手术病人共35例，术后发生胆胰漏12例，发生率为34．3％。经保守治疗、调整腹腔引流管或穿刺引流后治愈3例，另9例发生严重腹腔感染，再次手术行腹腔清洗和置管引流。结果再手术者中8例未行胆胰管支撑引流，其中6例术后胆胰漏之积液区未有效局限，腹腔感染持续并加重，3例并发腹腔出血；均行第3次手术，于胰管和（或）胆管内置管外引流，感染区留置双套管术后冲洗腹腔并负压引流；6例均存活，6个月后行决定性手术。结论胰十二指肠外伤行PD术后胆胰漏发生率高，再次手术时行胰管和（或）胆管内置支撑管外引流，可迅速有效地控制腹腔感染，降低死亡率。

Objective The objective of this study was to investigate the incidence and the opera- tion strategy of biliary and pancreatic leakage and related severe intra-abdominal infection after pancre- aticoduodenectomy （PD） due to abdominal trauma. Methods A total of 35 patients who underwent e- mergent PD in our department due to severe abdominal trauma during past ten years were retrospec- tively analyzed. Results Postoperative biliary and pancreatic leakages developed in 12 cases with an in- cidence of 34. 3%, in which 3 patients were cured by non-operating treatment, including peritoneal drainage tube, and other 9 patients had severe abdominal infectious complications and needed re-opera- tion. In these patients who required re-operations without biliary and pancreatic drainage, bile and pan- ereatic secreting fluid were not limited effectively, resulting in severe intraperitoneal infection in 6 ca- ses,in which 3 patients needed to be re-operated for the third time due to a massive bleeding. Other 6 patients were treated with effectively drainage by indwelling a double-tube into the biliary duct and/or pancreatic duct, and all 6 patients survived. Conclusion There is a very high incidence of biliary leak- age after emergent PD surgery due to severe intraperitoneal trauma. A biliary and pancreatic drainage can effectively control intra-abdominal infectious complications; thereby minimizing the mortality.