胰十二指肠切除术后吻合口裂开的预防与治疗策略

bPrevention and management of pancreaticoduodenal anasto-motic dehiscence

胰十二指肠切除术后吻合口裂开合并腹腔大出血是严重威胁患者生命的致死性术后并发症。因此，胰十二指肠切除术后吻合口裂开和继发腹腔大出血的预防与治疗，一直是胰腺外科争论的焦点。手术处理术后并发症仍然是最为稳妥的治疗方法。但再次手术探查难度较大、方法多变且不易掌握，术后有再次发生吻合口瘘和出血的危险，有些术式可能损害胰腺全部内、外分泌功能。我们对多例胰十二指肠切除术后发生腹腔大出血患者施行主胰管空肠桥式导管引流术，患者术后效果良好，救治率达100％。该术式操作简便、安全性高、救治率高，还可保留剩余胰腺功能，是一种简易可行的应急手术方法。

Pancreaticoduodenal anastomotic dehiscence complicated with peritoneal hemorrhage following pancreaticodu- odenectomy is a serious complication which threatens patients＇ life. Prevention and mangement of pancreaticoduodenal anasto- motic dehiscence and peritoneal hemorrhage is the focus in the surgical treatment. Operation is the most reliable treatment for bleeding. While reoperation is difficult for most surgeons and the risk of fistula and rebleeding after reoperation exist. Some proce- dures will affect the endocrine and exocrine function of pancre- as. We applied pancreaticojejunal bridge drainage for most patients with hemorrhage after pancreaticoduodenectomy. This procedure is easy, safe, and can protect the pancreatic function.