自制双腔引流管用于胰十二指肠切除术93例疗效分析

The clinical application of a novel drainage tube on the pancreaticoduodenectomy

目的分析自制双腔引流管对胰十二指肠切除术(PD)病人主要术后并发症(尤其是胰瘘)的影响。方法回顾性分析2009年9月至2011年7月复旦大学附属中山医院普外科胰腺专业组连续收治的93例因胰头良性或恶性肿瘤行PD病人的临床资料。术中均放置自制双点固定多位贯穿腹腔冲洗吸引双腔引流管。分析病人术后30 d内并发症发生及死亡情况。结果手术时间为(199.2±46.4)min,出血量为(190.8±193.2)m L,术中有8例病人输血,输血量为(2.0±0.2)单位红细胞。无一例出现引流管堵塞、移位。3例引流管处出现红肿、炎性反应,1例出现渗液。随访至术后30 d,57例病人术后未出现并发症,顺利出院,其余36例术后出现并发症。22例病人发生胰瘘,其中A级19例、B级3例;2例病人出现胆瘘;5例病人出现DGE;5例病人出现肺部感染;2例病人出现伤口感染。结论自制双点固定多位贯穿腹腔冲洗吸引双腔引流管安全可靠,有效减少了PD术后严重胰瘘的发生,提高了手术的安全性。

Objective To investigate the impact of using a novel drainage system in pancreaticoduodenectomy on the incidence rate of postoperative complications （especially the postoperative pancreatic fistula）. Methods The clinical data including the incidence rate and grade of postoperative pancreatic fistula and the occurrence rate of Biliary fistula, Delayed gastric emptying, bleeding and mortality within 30 days postoperative period of 93 patients who underwent pancreaticoduodenectomy using a novel drainage system from January 2009 to July 2011 were analyzed, retrospectively. Results The mean operation time was 199.2＋46.4 minutes, with the amount of bleeding 190.8_＋ 193.2 ml, 8 patients were performed the intraoperative transfusion and volume of transfusion 2.0~0.2 units. None of all the patients appeared displacement and blockage of drainage tube. Inflammation and redness happened in 3 patients, of which 1 was found oozing. All the patients were followed up to 30 days after the operation. 57 patients were not observed with complications and were discharged successfully. Of the other 36 patients, the occurrence amount of pancreatic fistula is 22, with grade A, grade B and grade C amount 19, 3 and 0, respectively. 2 of the patients take place the Biliary fistula and 5 appeared delayed gastric emptying （DGE）, 5 with pulmonary infection and 2 with wound infection. Conclusion The application of the novel two-point fixed, multisite running-through, double-lumen drainage tube in pancreaticoduodeneetomy was safe, and could reduce the incidence of high grade pancreatic fistula.