132例胰十二指肠切除术的临床分析

Clinical Analysis of Pancreatoduodenectomy in 132 Patients

目的:探讨胰十二指肠切除术手术适应证、消化道重建方式及术后并发症的原因和防治经验。方法:回顾分析2006年1月-2013年12月本院132例患者胰十二指肠切除术的治疗经验。结果:术中无死亡病例。消化道重建方式均为Child术式,其中胰肠吻合方式:传统胰腺空肠端端吻合术11例;捆绑式胰腺空肠吻合术24例;胰腺空肠端侧吻合术84例;胰腺空肠导管对黏膜吻合13例。132例全部经病理学确诊,其中胰头癌72例,壶腹部周围癌28例,胆总管下段癌15例,十二指肠癌5例,慢性胰腺炎3例,胰头浆液性囊腺瘤6例,胰腺导管内乳头状黏液瘤3例。术后并发症发生率34.1%,其中术后出血6例(4.5%),胰瘘22例(16.7%),肺部感染8例(6.1%),胆瘘5例(3.8%),胃排空障碍4例(3.0%)。结论:胰十二指肠切除术是腹部外科较复杂的手术,是胰头癌患者最有效的治疗手段,应严格掌握其手术适应证。出血、胰漏、胆漏和腹腔感染等是PD术后主要并发症,术中仔细操作并采用合适的吻合方法,术后密切观察和积极处理并发症是减少PD术后并发症和病死率的关键。

Objective：To analyse the surgical indication,digestive tract reconstruction and postoperative complications of pancreatoduodenectomy（PD）and study measures for prevention and treatment of the complications. Method：132 patients undergoing PD in our hospital from January 2006 to December 2013 were reviewed retrospectively. Result：There was no operative mortality in all cases. Gastrointestinal surgical reconstruction are the Child surgery,the pancreatojejunostomy of which were：traditional pancreatic jejunal anastomosis 11 cases;bundled pancreatic anastomosis 24 cases;pancreas jejunum end to side anastomosis 84 cases;pancreatic duct on jejunal mucosa anastomosis 13 cases. All 132 cases were diagnosed by histopathology,including 72 cases of pancreatic cancer,28 cases of ampullary carcinoma, 15 cases of common bile duct cancer,5 cases of duodenal cancer,3 cases of chronic pancreatitis,pancreatic gland serous tumor in 6 cases,intraductal papillary mucinous tumors of the pancreas in 3 cases. There were 45 cases（34.1%） occurred complications after PD,including 6 cases（4.5%）of hemorrhage,and 22 cases（16.7%）of pancreatic fistula, 8 cases（6.1%）of pulmonary infection,5 cases（3.8%）of bile duct fistula,and 4 cases（3.0%）of functional delayed gastric emptying.Conclusion：PD is a more complicated abdominal surgery,which is still the most effective treatment for pancreatic cancer patients. The surgical indications should be strictly controlled. The main complications after PD were hemorrhage,Pancreatic fistula,bile duct fistula and intra-abdominal cavity infection. Meticulous operative technique, the selection of appropriate anastomoses technique,timely aggressive management in the postoperative period are the key points to reduce complication and mortality rate after PD.