胰十二指肠切除术后早期并发症的分析及处理

The analysis and treatment to early complications of Pancreaticoduodenectomy

目的探讨胰十二指肠切除术(PD)后早期并发症的原因及其防治方法。方法回顾性分析我院2007年3月～2012年9月间实施胰十二指肠切除术30例患者的临床资料。结果术后发生早期并发症9例(30.0%),包括腹腔内出血2例(6.7%),胰瘘5例(16.7%),胆瘘2例(6.7%),腹腔内感染1例(3.3%),围手术期死亡1例(3.3%)。统计学分析显示:术前血清胆红素水平≥171 mmol/L,血清白蛋白水平<35 g/L,术中失血量≥600 ml术后并发症发生率显著增高。结论出血、胰瘘、胆瘘和腹腔内感染等是PD术后主要的早期并发症,围手术期恰当的处理,术中仔细操作并采用合适的吻合方法,术后密切观察和及时积极的处理是减少PD术后并发症和病死率的关键。

Objective To explore the reason and prevention methods for early complications of Pancreaticoduodenectomy. Methods We have analysed retrospectively 30 patients＇clinical datas implemented PD between March of 2007 to September of 2009 in our hospital. Results There exist 9 cases of early complications of Pancreaticoduodenectomy（30.0% ）. Including 2 cases of intra-abdominal hemorrhage（6. 7% ） ; 5 cases of pancreatic fistula（ 16. 7% ） ; 2 cases of biliary fistula（6. 7% ） ; 1 case of intra - abdominal infection（3. 3% ）; 1 death during perioperative period （3.3%）. Total uncinate process resection, preoperative total serum bilirubin level （ ≥ 171 μmol/L）, preoperative serum albumin level（ 〈 35 g/L）, intraoperative blood transfusion （≥ 600 ml） were identified as significant risk factors for postpanereatoduodenectomy complications by means of univariate analysis. Conclutions The main early complications of PD are bleeding,pancreatic fistula,biliary fistula and intra-abdominal infection. There are some critical factors to reduce the complications and deaths of PD ,like appropriate treatment during perioperative period, careful operation and adopting appropriate anastomosis method when performing surgery, observe closely and active treatment timely postoperation.