远端胰腺切除术胰漏的三级预防策略

Three-Grade Protective Regimen for Pancreatic Leakage in Distal Pancreatectomy

临床针对各种胰腺体尾部病变常需实施远端胰腺切除术,但胰漏的发生率仍居高不下,成为困扰外科临床医师的难题。为此,笔者提出预防胰漏的三级策略。一级预防针对胰腺本身,通过缝扎被切断的次级胰管开口和抑制胰液分泌,减少胰液分泌到胰腺组织外;二级预防针对胰腺断端,通过改进远端胰腺切除手术方式,利用带血管蒂浆肌瓣贴敷胰腺断面促进其愈合,防止胰液外漏到周围组织;三级预防是发生胰漏后及时采取切实有效的治疗措施,防止发生与胰漏相关的严重并发症导致病情恶化,使患者早日康复,提高治愈率。

Distal pancreatectomy is the most common surgical procedure for treating benign and malignant lesions in the body or tail of the pancreas. The most frequent and dismal complication occurring after operation is the development of postopera-tive pancreatic leakage. Three-grade protective regimen for pancreatic leakage in distal pancreatectomy is discussed in this pa-per. The aims and ways of the primary prevention are pancreatic parenchyma and function. Pancreatic juice secretion to the out-side of the pancreas is reduced through the seam cut secondary pancreatic duct openings and inhibition of pancreatic secretion. Those of the secondary prevention are pancreatic stump. Taking modified distal pancreatectomy can facilitate coalescence of the pancreatic section with pedicled seromuscular flap, and reduce pancreatic juice leakage to the surrounding tissue of the pancre-as. The tertiary prevention is to reduce complications caused by pancreatic leakage. Exact and effective treatment measures in a timely manner is taken to prevent condition worsens, promote recovery procedure, and improve the cure rate.