胰体尾切除术后胰瘘的防治

Experience in prevention and treatment of post distal pancreatectomy fistula

目的探讨胰体尾切除术后胰瘘的防治。方法回顾性分析2007年1月至2014年5月间83例行胰体尾切除术病人的术前基本资料、术中操作及术后治疗等临床资料，对其中并发胰瘘的19例病人临床资料进行分析。结果行胰体尾切除术的83例病人中，术后并发胰瘘19例，发生率为22．9％，16例经保守治疗痊愈，有效率为84．2％，2例病人行放射治疗后治愈，1例死亡，死亡率为1．2％。单纯缝扎和切割闭合器处理胰腺断端后胰瘘发生率分别为21．6％和23．9％。结论胰体尾切除术后胰瘘的发生率仍然很高，术中正确处理胰腺断端及加强术后管理是预防胰体尾切除术后胰瘘的关键。胰瘘的治疗在于通畅引流、加强营养支持，并积极寻找新的治疗方法。

Objective To explore the proper way of prevention and treatment of pancreatic fistula after distal pancreatectomy. Methods We retrospectively reviewed the basic information and operation techniques and postoperation treatment of 83 patients who received distal pancreatectomy in our hospital/tom January 2007 to May 2014, and we analyzed the clinical data of 19 patients who showed pancreatic fistula after the surgery. Results Of 83 patients who underwent distal pancreatectomy, 19 showed pancreatic fistula, the incidence rate was 22. 9%. 16 patients were cured by expectant treatment （84. 2 %）, and 2 patients were cured by radiotherapy, 1 patient dead, the death rate was 1.2%. The pancreatic fistula rate after hand-sewn closure and stapler are 21.6% and 23.9% respectively. Conclusions The incidence of pancreatic fistula after distal pancreatectomy is still high. The prevention of pancreatic fistula after distal pancreatectomy lies in proper management of pancreatic stump during the surgery and postoperative care. Effective drainage of the pancreatic stump combined with nutritional support is radical in the treatment of pancreatic fistula. New treatment need to he found to manage the pancreatic fistula after distal pancreatectomy.