奥曲肽对胰十二指肠切除术后并发症的防治及其机制探讨

The Preventive Effect of Octreotide on Postoperative Complications of Pancreaticoduodenectomy

目的 探讨奥曲肽 (Outreotide)对胰十二指肠切除术后并发症的防治作用及机制。方法 胰十二指肠切除术患者 96例 ,随机分为两组 :( 1)治疗组 :5 8例 ;( 2 )对照组 :38例。在综合治疗的基础上 ,治疗组加用奥曲肽皮下注射 ,对照组加用洛赛克加 5 %葡萄糖静脉推注 ,两组疗程均为 7～ 10d ,并观察两组病人术后 1周内平均每日消化液引流量以及术后严重并发症的情况。结果 两组病人术后 1周内平均每日消化液引流量 :治疗组 :胰液 ( 5 3± 8)ml,胆汁 ( 172± 2 7)ml,胃液 ( 2 12± 39)ml;对照组 :胰液 ( 2 6 8± 4 6 )ml,胆汁 ( 385± 5 2 )ml,胃液 ( 318± 6 0 )ml,两组相比较 ,治疗组低于对照组 ,有显著性差异 (P <0 .0 1)。术后严重并发症发生率 :治疗组为 14 % ( 8/ 5 8) ,对照组为37% ( 14 / 38) ,两组相比较 ,治疗组低于对照组 ,有显著性差异 (P <0 .0 1) ;术后胰瘘 :治疗组为 3例 (占 5 .2 % ) ,对照组为 7例 (占 18.4 % ) ,两组相比较 ,有显著性差异 (P <0 .0 5 )。死亡 5例 :其中治疗组 1例 ,对照组 4例。结论 奥曲肽可明显减少消化液的分泌量 。

Objective To explore the preventive effect of octreotide on the postoperative complications of pancreaticoduodenectomy.Methods From Jan 1990 to December 2002 patients undergoing pancreaticoduodedectomy were divided into octreotido group( n =58) and control group( n =38).The daily digestive juice output and the severe complications were retrospectively analyzed.Results The daily digestive juice output in octreotide group within one week Was:pancreatic juice of(53±8)ml,bile(172±27)ml and gastric juice(212±39)ml v.s of(268±46)ml,(385±52)ml,and(318±60)ml in the control group(all P <0.01);The incidence of severe complications in octreotide group was 14% vs 37% in the control(χ 2=6.90, P <0.01).The mortality rate in octreotide group was 2% vs.10% in the control group.Conclusion Octreotide effectively prevents or decreases the incidence of severe complications after pancreaticoduodenectomy.