生长抑素及生长激素预防胰十二指肠切除术后并发症发生的临床应用

目的　探讨生长抑素 14肽与生长激素联合应用在预防胰十二指肠切除术后并发症发生中的作用。方法　我院 1995年 3月至 2 0 0 3年 3月共收治因胆总管下段癌、十二指肠乳头癌及胰头癌行胰十二指肠切除术患者 4 8例 ,对其中 2 6例 (治疗组 )应用生长抑素 14肽 6mg/d(持续微量泵泵入 )及生长激素 8U/d(分两次肌注 )治疗 ,余 2 2例为对照组 ,术后常规应用全肠外营养及抗生素治疗 ,比较两组的治疗结果。结果　术后发生并发症对照组 17例 (77.3% ) ,治疗组 5例 (19.2 % ) ,两组比较差异有显著性意义 (P<0 .0 5 )。治疗组胰液量及胰周引流液中淀粉酶的含量明显低于对照组 (P<0 .0 5 ) ,两组术前、术后蛋白质指标 ,治疗组于术后第 7天基本恢复到术前水平 ,而对照组第 10天才达到术前水平。结论　联合应用生长抑素及生长激素能有效降低胰十二指肠切除术后并发症的发生率     

生长抑素预防胰十二指肠切除术后胰瘘及其他并发症的meta分析

目的 用循证医学的方法 评价预防性使用生长抑素能否降低胰十二指肠切除术后并发症。方法 检索1966年到2006年7月间发表的有关胰十二指肠切除术预防性使用生长抑素的效果的随机对照临床试验。按入选和排除标准，有7项临床试验纳入本研究，由2名评价者对入选研究中有关试验设计、研究对象的特征、研究结果 等内容独立进行摘录，用RevMan4.2软件进行分析。结果 对于胰十二指肠切除术生长抑素预防性使用组和不使用组两组之间胰瘘（OR=0.70，95%CI：0.42～1.16，P=0.17）、总并发症（OR=1.12，95%CI：0.73～1.70，P=0.61）、住院期间死亡数（OR= 1.61，95%CI：0.52～5.03，P=0.41）、住院天数（OR=-2.87，95%CI：-9.83～4.10，P=0.42）差异均无统计学意义。结论 预防性使用生长抑素并不能降低胰十二指肠切除术后胰瘘、总并发症、住院期间死亡数和住院天数，不推荐在胰十二指肠切除术前和术后常规应用生长抑素来预防术后并发症。     

生长抑素预防胰十二指肠切除术后胰瘘的对比研究

目的　探讨生长抑素八肽 (又称 Octreotide奥曲肽 ,商品名善宁 )在胰十二指肠切除术后抑制胰液的分泌、预防和治疗胰瘘的作用。方法　对照组 :1990年 1月至 1995年 4月收治的 31例胰十二指肠切除术 ,术后未应用生长抑素八肽 ;实验组 :1995年 5月至 1999年 12月收治的 45例胰十二指肠切除术 ,术后常规应用生长抑素八肽 0 .1m g,每 8h皮下注射一次。胰十二指肠切除术均采用 Child术式。结果　对照组术后胰液分泌为 2 35 .5 3± 111.77ml/d,实验组术后胰液分泌为 133.0 9±112 .35 ml/d,实验组术后胰液分泌比对照组显著减少 ,差异有显著性意义 ( P<0 .0 5 )。对照组术后发生胰瘘 4例 ,未应用善宁治疗 ,死亡 3例。实验组术后发生胰瘘 3例 ,常规应用善宁治疗 ,无死亡病例。结论　善宁用于胰十二指肠切除术术后抑制胰液分泌、预防胰十二指肠切除术后胰瘘的发生和治疗胰瘘疗效可靠 ,能够降低术后胰瘘的发生率和术后死亡率具有重要的临床应用价值。     

胰十二指肠切除术并发胰漏的预防体会

1990年 1月～ 1999年 12月本院共行胰十二指肠切除术 2 7例 ,仅 1例术后并发胰漏 ,其发生率为3.3% ,报告如下。1　临床资料本组中男性 19例 ,女性 8例 ,年龄 36～ 6 5岁。其中胰头癌 19例 ,十二指肠乳头癌 3例 ,胆总管下段癌 4例 ,1例为胆总管下端结石嵌顿术中损伤壶腹部无法修复。消化道重建的方式采用Ｃｈｉｌｄ术式2 6例 ,并在胃肠吻合口以下的远近端空肠间常规行侧 -侧吻合。其中胰肠吻合的方式为 :胰腺 -空肠端端套入式吻合 5例 ,胰管 -空肠粘膜端侧吻合 7例 ,捆绑式吻合 14例。采用胰 -胃吻合 1例。 2 7例中胰管中置管 2 4例 ,并同时…     

如何防治胰十二指肠切除术并发症

壶腹周围癌的发病率有逐年上升趋势。胰十二指肠切除术 (PD)是唯一可以给它带来治愈希望的方法 ,然而 PD的并发症一直制约着其发展。尽管近年来已有不少医院在开展该项手术 ,但其并发症的防治问题仍需外科医生密切注意。本文着重讨论其中重要的并发症 :包括胰漏、胆漏、出血、胃排空障碍和内疝。1　胰漏为了预防胰漏 ,文献中已出现了 2 0余种方法 ,大体上包括胰腺残端结扎、胰管栓塞、胰空肠吻合和胰胃吻合等。胰管结扎方法简单 ,但胰漏发生率高达 50 % ,已经淘汰不用。胰管栓塞带来长期的胰腺外分泌不足 ,而且并非每个病人的胰断端均能找…     

胰十二指肠切除术后胰漏的预防

胰漏是胰十二指肠切除术后最常见和最严重的并发症,早期发生率高达25%[1]。近10多年来我院共施行保留幽门式胰十二指肠切除术56例,仅1例发生胰漏,胰漏发生率为1.8%,现将体会报告如下:1临床资料1.1一般资料:本组56例中男25例,女31例。年龄32~76岁,平均56.5岁。其中壶腹癌19例,胰头癌16例,胆总管下段癌18例,十二指肠乳头癌3例。1.2手术方法:本组56例均行保留幽门式胰十二指肠切除术,消化道重建均采用Child术式重建。胰空肠端端吻合采取钟守先[2]吻合法,并置脑室引流管1根于胰管内,用3-0肠线或细丝线缝扎固定在胰管壁上,远端经空肠腔内潜行约1…     

胰十二指肠切除术后并发症

１９８５年１月～１９９５年１２月，我院行胰十二指肠切除术１１５例，术后死亡率７０％（８例）。并发症发病率为３７４％（４３例），包括胃排空延迟１９１％（２２例），胰空肠吻合口漏７８％（９例），腹腔脓肿７０％（８例），胆肠吻合口漏６１％（７例），应激性溃疡８７％（１０例）和腹腔内出血７０％（８例）。并发症与高龄，手术时间长和术中大量出血有关，大多数以非手术治疗而愈。当需再次手术，死亡率增加。术后并发症的处理以简单和保守为原则。     

胰十二指肠切除术后并发症的防治体会

目的 探讨胰十二指肠切除术后并发症的预防方法.方法 回顾性分析60例胰十二指肠切除术后并发症的发生及防治方法.胰肠吻合全部采用贯穿缝合式胰肠吻合术.结果 术后胰瘘、胆瘘、出血、胃排空障碍等并发症共7例,发生率11.7％,无手术死亡.结论 胰十二指肠切除术手术范围广、吻合多、创伤大,一直具有较高的死亡率和并发症发生率,但精细的手术操作、简单可靠的胰肠吻合方法以及合理的技术改进可以减少手术后并发症的发生.     

预防性应用生长抑素对降低胰十二指肠切除术后并发症的Meta分析

目的:以循证医学证据评价胰十二指肠切除术预防性使用生长抑素的临床疗效。方法:通过计算机检索Pubmed数据库、EMBASE、万方数据库、中国全文期刊数据库和维普数据库,并结合文献追溯、网上查询(www.baidu.com;www.google.com)的方法,收集关于预防性应用生长抑素在胰十二指肠切除术后临床疗效的随机对照试验,并按Cochrane协作网推荐的方法对符合纳入标准的11个研究共1041例病人进行Meta分析,发表偏倚用漏斗图评估。结果:与对照相比,预防性应用生长抑素能降低胰十二指肠切除术后总并发症的发生率(P=0.04),但二者在术后胰瘘发生率(P=0.13)、围手术期病死率(P=0.69)、住院天数(P=0.52)方面均无统计学差异。结论:Meta分析结果显示术后预防性应用生长抑素,能在一定程度上降低术后并发症的发生,但是不能有效预防胰瘘的发生、降低围手术期病死率和缩短住院天数。由于纳入的样本存在选择偏倚、发表偏倚及测量偏倚的可能性,影响结果的论证强度,最终结论需要进行更多高质量的随机对照试验。     

降低胰十二指肠切除术后外科并发症的临床体会

目的探讨减少胰十二指肠切除术后外科并发症的方法。方法对我科2004年1月-2010年1月行胰十二指肠切除术的77例患者术式选择和术后并发症进行回顾性分析。结果77例均作标准的Whipple术,胰颈空肠套人端侧吻合51例,套入端端吻合21例,胰管空肠粘膜吻合5例,全组77例中共9例发生外科并发症,其中胰漏3例,上消化道出血2例,腹腔出血1例,功能性胃排空障碍3例。结论注意术式选择的个体化和精细的手术技巧是减少胰十二指肠切除术后严重并发症发生的重要措施。     

新型T型管在胰十二指肠切除术中的应用

为了合理引流胰液,以预防胰十二指肠切除术后胰瘘的发生和减少术后并发症,对31例手术病人采用Child术式及胆肠吻合口置T型管引流,并用自行设计的新型T型管置胰肠吻合口胰管内引流胰液,术后无胰瘘和胆瘘发生。此新型T型管首次用于胰液引流,具有集胰管内、外引流管于一体,确能起到合理引流胰液以预防胰瘘的作用。该方法实用,简便易行,且效果满意。     

胰腺癌胰十二指肠切除术后并发症回顾性分析

目的 回顾分析胰十二指肠切除术（PD）后并发症的相关因素,探讨预防减少术后并发症的措施。方法 回顾性研究我院1994年1月至2006年12月问138例PD病例,分析影响PD术后并发症的危险因素,比较不同胰肠吻合方式及幽门保留与否对胰瘘的影响。比较保留幽门的PD（PPPD）与不保留幽门的PD对术后胃潴留发生率的影响。结果 术后胰瘘总发生率23．18％（32／138）,其中胰空肠黏膜对黏膜侧侧吻合组22．48％（29／129）,胰残端空肠端侧传统套入组33．33％（3／9）。PPPD术后胃潴留发生率显著高于PD。胰肠吻合方式、保留幽门与否并不显著性的影响胰瘘的发生。多数手术近期吻合口出血与应用胃肠吻合器有关。结论 胰肠吻合方式、保留幽门与否未能显著的影响PD后胰瘘的发生,但保留幽门后会增加胃潴留的发生率;慎重应用胃肠吻合器,人工手法细心进行胃肠吻合可能有助于预防胰腺癌手术后近期出血的发生。     

UROLOGICAL COMPLICATIONS FOLLOWING ABDOMINOPERINEAL EXCISION OF THE RECTUM FOR CARCINOMA

A retrospective study was made of 122 patients who had an abdominoperineal excision (APE) of the rectum for carcinoma at Concord Hospital between 1971 and 1979. Fifty-two percent of patients suffered one or more significant urological complications. These included urinary tract infection (32%), operative trauma to the urinary tract (8.5%) and temporary or permanent bladder dysfunction in 35% of patients. Acute urinary retention, when temporary, was managed by simple measures. Chronic retention, incontinence and some episodes of acute retention were due to a neurogenic bladder. These patients were difficult to treat. It is recommended that urodynamic studies be used to assess these patients who develop a neurogenic bladder before any treatment is instituted. This is relevant especially in those patients in whom a transurethral resection of either the bladder neck or prostate is contemplated.     

A METHOD FOR THE TREATMENT OF URETERIC COMPLICATIONS FOLLOWING RENAL TRANSPLANTATION

Over an 8 year period, 117 renal transplants (97 cadaveric and 20 living related) were performed at the Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. Ureteric complications following renal transplantation occurred following seven transplants (6%). The technique of using a multiply fenestrated vesicocutaneous stent/drain to manage this problem is described. This was uncomplicated in all cases with the exception of one case in which the stenvdrain was removed early because of blockage and sepsis, but most importantly on no occasion was the graft lost. We therefore recommend this technique for the management of this complication, whether early or late. We observed a disproportionate number of ureteric complications in living related transplants, a feature not described previously.     

根治性胰头十二指肠切除术在胃下部癌中的应用

报告12例胃下部癌行根治性胰头十二指肠切除术(RPD),取得了满意的临床效果。认为胃下部癌侵及胰头和(或)十二指肠者为绝对适应证。而N3( )者为相对适应证,第16组淋巴结转移者应放弃RPD。淋巴结的清除范围达D_3即可。适应证的选择应从严掌握,须结合病人的年龄、一般状况、重要脏器功能及经济条件等因素综合考虑。对胃癌侵及胰腺和淋巴结转移的判定应慎重,必要时需行冰冻活检。并对该手术的有关问题进行讨论。     

LONG SURVIVORS AFTER PANCREATODUODENECTOMY FOR PANCREAS HEAD CARCINOMA

Twelve Japanese patients with pancreas head carcinoma who survived 3 years or more after a pancreatoduodenectomy and 50 who survived less than 12 months were reviewed clinicopathologically. The 12 patients who survived for ≥ 3 years exhibited more favourable prognostic factors: a higher incidence of jaundice; a smaller mass; a higher prevalence of an earlier stage tumour and adenocarcinoma of differentiated type; and a lower incidence of venous invasion, lymph node metastasis, and cancer cells at the surgical margins. However the difference was not significant. Univariate log-rank analysis regarding 13 prognostic variables showed that histologic type was a significant factor but multivariate Cox regression analysis failed to reveal an independent significant parameter. Nine of the 12 long-term survivors showed lymph node metastasis and six of the 12 revealed cancer cells at the surgical margins. Six of the 12 long-term survivors died from local recurrence and/or distant metastasis 37–78 months after operation. Only two patients survived more than 5 years after the operation. At the time of writing, one of them was still alive and another was dead 78 months after the operation. Pancreatoduodenectomy for pancreas head carcinoma infrequently offers a permanent cure for the patients with pancreas head carcinoma but sometimes produces a worthwhile long-term survival, even if the resected margins were affected by malignant cells or the lymph node metastasis was evident.     

会阴部人工肛门手术并发症的防治

自1986年以来，在直肠癌腹会阴联合切除后采用耻骨直肠肌修复或保存的方法行会阴部人工肛门72例，48．6％发生术后并发症，包括感染10例、狭窄6例、粘膜脱垂10例、人工肛门周围皮肤靡烂8例及复发1例。讨论了这些并发症发生的原因，并提出其防治措施。     

肝癌肝切除术后并发症及其防治

目的总结和探讨肝切除患者术后常见并发症及其防治经验。方法回顾性分析288例肝癌肝切除术后围手术期并发症及其处理。结果术后并发症包括肝肾功能不全(44例),胸腔积液(10例),腹腔继发出血(8例),上消化道出血(6例),胆汁漏(6例),切口感染(6例),肺部感染(4例),切口疝(4例),腹腔脓肿(2例),自发性气胸(2例)。有并发症组和无并发症组患者的血浆白蛋白(ALB)、总胆红素(TB IL)、凝血酰原时间(PT),肝硬化情况以及术中失血量、手术时间、切除范围、肝门阻断时间存在差异(P<0.05)。全组因并发症死亡12例,病死率4.2%(12/288)。结论术前改善肝功能储备、提高手术技巧及了解各种并发症的发生时间和症状是防治肝切除术后并发症的关键因素。     

生长抑素治疗急性胰腺炎的临床研究

目的 探讨生长抑素治疗急性胰腺炎的临床效果。方法 应用人工合成的生长抑素类似物－－奥曲肽治疗３８例和非奥曲肽治疗５９例急性胰腺炎。观察了两组以及奥曲肽治疗用药前后血甭淀粉酶及胰液粉酶的含量,比较了两组并发症的发生率。结果 奥曲肽能有效降氏血清淀粉酶和胰液淀粉酸酶的活性,改善临床症状和体征,降低并发症的发生。结论 奥曲肽有助于性胰腺炎的治疗。     

MANAGEMENT OF BILIARY TRACT COMPLICATIONS FOLLOWING LIVER TRANSPLANTATION

Background : A review of biliary tract complications was performed in 32 patients who underwent liver transplantation by the Western Australian Liver Transplantation Service during a 2-year period. Methods : A review was made of patient data collected prospectively, and confirmed by retrospective casenote review. Results : A total of 30 patients (31 grafts) survived more than 2 days after transplantation, and of these 28 had an end-to-end biliary anastomosis. Analysis of these 28 patients found that eight of 17 patients with T-tubes had complications: three leaks at T-tube removal; two strictures and leaks; and three strictures. Six of 11 patients without a T-tube had complications: one leak; three strictures and leaks; and two strictures. Predisposing factors were present in eight of the 14 patients with biliary tract complications: hepatic artery stenosis in three; and one each with hepatic artery thrombosis; biliary calculi; donor–recipient bile duct mismatch; severe cellular rejection; and prolonged postoperative hypotension. Acute rejection, steroid-resistant rejection and cytomegalovirus infection were all significantly more common in those patients with biliary tract complications compared with those without. There was no difference in cold ischaemic time or donor age. Twelve of the 14 patients with biliary complications required endoscopic stenting with or without balloon dilation, and eight patients required radiological percutaneous drainage of bile collections. Only one patient required biliary reconstruction and two patients required re-transplantation. One patient died of uncontrolled infection. Of three patients who underwent choledochojejunostomy, biliary leak developed in two patients, both of whom required operative biliary and hepatic repair. One of the three patients died from disseminated Aspergillus infection. The median total hospital stay of patients with biliary complications was 61 days (range: 30–180 days) compared with 33.5 days (range: 22–70 days) for patients without. Of patients with end-to-end biliary anastomosis, 50% had biliary tract complications and more than half of these had predisposing factors. The majority of biliary complications were managed without the need for surgery. Conclusion : A total of 50% of patients with end-to-end biliary anastomosis had biliary tract complications. Biliary strictures presented later than leaks, and the majority of these complications were managed without the need for surgery.