胰十二指肠切除术后胰瘘的危险因素、预后及预防的探讨

Study on Risk Factor, Prognosis and Prevention of Pancreatic Fistulas after Brunschwig's Operation

目的探讨胰十二指肠切除术后胰瘘的危险因素、预后及预防效果。方法整群选取该院门诊收治的行胰十二指肠切除术发生胰痿的96例患者作为研究对象,患者的收治时间在2012年4月—2015年5月,随机将所有患者分为两组,各有患者48例,一组患者接受治疗(观察组),另一组患者不接受治疗(对照组),分析可能导致胰痿发生的危险因素,并探讨其预防措施。结果患者的年龄与胰痿的发生无关(P>0.05);胰痿的发生与血清胆红素水平、术中出血量、手术时间等因素有关(P<0.05);接受治疗后的胰痿患者并发症发生率(4.17%)、痿口愈合率(95.83%)、痿口愈合时间(11.12±2.33)d及住院时间(15.52±12.54)d明显优于未接受治疗的患者(P<0.05)。结论胰十二指肠切除术后胰瘘发生的危险因素有很多,如手术因素、疾病相关因素等,通过采用药物治疗及术前、术中及术后干预措施,对胰痿的防治具有重要的临床意义。

Objective To discuss the risk factor, prognosis and prevention of pancreatic fistulas after brunschwig＇s operation. Methods 96 cases of patients with pancreatic fistulas after the brunschwig＇s operation admitted and treated in clinics of our hospital from April 2012 to May 2015 were selected as the research object and randomly divided into two groups with 48 cases in each, the observation group received treatment, the control group did not receive treatment, the risk factors perhaps leading to pancreatic fistulas were analyzed, and its preventive measures were discussed. Results The ages of patients were not correlated with the occurrence of pancreatic fistulas（P〉0.05）, the occurrence of pancreatic fistulas was correlated with the serum bilirubin level, intraoperative blood loss and operation time and so on（P〈0.05）, the incidence rate of complications, fistulas healing rate, fistulas healing time and length of stay in patients with pancreatic fistulas after treatment were respectively 4.17%, 95.83%, （11.12±2.33） d and （15.52±12.54） d, which were obviously better than those of patients without treatment （P〈0.05）. Conclusion The risk factors of the occurrence of pancreatic fistulas after brunschwig＇s operation are a lot, including the operative factors and disease-related factors, the drug treatment and preoperative, intraoperative and postoperative interventional measures are of important clinical significance to the prevention and treatment of pancreatic fistulass.