胰十二指肠术后胰瘘合并腹腔感染的诊疗分析

Diagnosis and treatment of pancreatic fistula complicated with abdominal infections after pancreaticoduodenectomy

目的探讨胰十二指肠切除术后胰瘘合并腹腔感染患者的诊断与治疗方法,以采取有效措施。方法回顾性分析医院2008年1月-2011年12月137例行胰十二指肠切除术患者的临床资料,对于临床怀疑胰瘘合并腹腔感染的患者行血液及引流液培养、腹部CT等检查,一经确诊,即给予充分引流、抗菌药物等综合治疗措施。结果 19例胰瘘合并腹腔感染的患者中,发生胰瘘31例,胰瘘发生率为22.6%,其中19例合并腹腔内感染,感染率为13.9%;137例患者送检标本中检出阳性标本26例次,包括单一菌感染12例、混合感染7例;共培养出病原菌26株,其中粪肠球菌11株占42.3%,大肠埃希菌8株占30.8%,金黄色葡萄球菌3株占11.5%,18例患者经治疗后好转,死亡1例。结论对于胰瘘合并腹腔感染的患者,影像学检查及病原学检查尤为重要,保持充分引流和应用抗菌药物是治疗的有效措施。

OBJECTIVE To find the effective diagnosis and treatment of pancreatic fistula complicated with abdominal infection after pancreaticoduodenectomy so as to take effective measures.METHODS We retrospectively analyzed the clinical data of 137 patients who underwent the pancreaticoduodenectomy from Jan 2008 to Dec 2011.The patients suspicious of pancreatic fistula complicated with abdominal infections which were diagnosed by examination of blood,fluid,and image（such as abdominal CT scan） were immediately treated with puncture drainage and antibiotics.RESULTS Totally 31 patients（22.6%） were diagnosed of pancreatic fistula,and 19 patients（13.9%） were diagnosed of pancreatic fistula complicated with abdominal infections.Of the submitted specimens from 137 patients,totally 26 case-times of specimens were detected positive,including 12 cases of single infection and 7 cases of mixed infections.Totally 26 pathogenic strains were isolated,among which there were 11 strains（42.3 %） of Enterococcus faecalis,8 strains（30.8 %） of Escherichia coli and 3 strains（11.5%） of Staphylococcus aureus,18 patients were cured,and one patient died.CONCLUSION Image examination and pathogen detection are the most important approaches to figure out the patients with pancreatic fistula complicated with abdominal infection,and the puncture drainage and antibiotics are the effective treatment measures.