胰十二指肠切除术后胰瘘的原因及对策

目的探讨胰十二指肠切除术（PD）后胰瘘的原因及防治经验。方法回顾性分析209例胰十二指肠切除术患者的临床资料，对术后胰瘘的原因、预防、治疗进行分析。结果胰瘘的发生与年龄、性别、胰腺质地，术前有无黄疸、贫血、低蛋白血症以及不同的胰肠吻合方式无相关性。而不同的手术组别（手术技巧等）与胰瘘发生率比较差异有统计学意义。结论恰当的围术期处理，娴熟的手术操作能够明显降低胰瘘的发生率，且胰、肠吻合方式的个体化处理是预防PD术后胰瘘发生的关键。

Causes and countermeasures of pancreatic fistula after pancreaticoduodenectomy

Objective To discuss the experiences in the prevention and treatment of pancreatic fistula after pancreaticoduodenectomy. Methods We retrospectively analyzed 209 cases received pancreatieoduodenectomy from 1995 to 2010. We analyzed the causes of pancreatic fistula, prevention and treatment of pancreatic fistula. Results Incidence of pancreatic fistula had no significant difference be- tweenthe different age, gender, pancreatic texture, with or without preoperative jaundice, anemia, hy- poproteinemia and different surgical approach of pancreatojejunostomy. Incidence of pancreatic fistula had significant difference between different surgical groups （surgical techniques）. Conclusions Appropriate perioperative management, skilled surgical operation can significantly reduce the incidence of pancreatic fistula. Skilled surgical operation, particularly pancreatic and intestinal anastomosis individualized treatment is crucial to prevent pancreatic fistula after PD.