防范Whipple术后胰瘘的临床体会

EXPERIENCE OF THE PREVENTION OF PANCREATIC FISTUL A AFTER PANCREATICODUODENECTOMY

目的 探讨预防胰十二指肠切除术后胰瘘的经验。方法 回顾性总结胰十二指肠切除术 4 2例的临床资料 ,实施胰空肠端端套入吻合术 2 8例 ,捆绑式胰肠吻合术 14例。全组病人均放置胰管支撑引流 ,外引流 18例 ,内支架管引流 2 4例。结果 全组无胰瘘发生 ,术后并发伤口感染 2例 ,胃排空障碍 1例 ,肺部感染 1例 ,胃肠出血 1例 ,腹腔脓肿 1例 ,胆瘘 1例。并发症发生率为 16 .7%。内支撑引流的病人术后恢复明显快于完全外引流的病人。结论 胰管内支撑引流、精细的胰肠吻合和有效的围手术期治疗是预防

Objective To study the prevention of pancreatic fistula after pancreaticoduodenectom y.Methods A retro- spective analysis was made on4 2 patients with pancreaticoduodenectomy from January1997to February2 0 0 2 .In 4 2 cases a pancreaticojejunostom y was perform ed,2 8in an end- to- end invaginated fashion,and 14 in an end- to- end binding fashion.Re- sults The postoperative morbidity rate was16 .7% (7/ 4 2 ) ,including wound infection in2 cases,residual gastric emptying dysfuntion in1case,pulm onary infection in1case,biliary fistula in1case,intra- abdominal abscess in1case,gastrointestinal bleeding in 1case.Of the 4 2 cases,no postoperative pancreatic fistula occurred and no in- hospital death.Conclusion Pancre- atic duct endoprosthetic stent,delicate pancreaticojejunal anastomosis and effective perioperative management are a key to prevent pancreatic fistula after pancreaticoduodenectom y.