胰十二指肠切除术胰漏发生与治疗相关因素的关系

目的探讨胰十二指肠切除术（PD）胰漏的发生与给予临床治疗相关因素的关系。方法收集2002年1月至2007年10月135例行PD术患者的临床资料,对其进行回顾性分析。结果135例中术后发生胰漏6例（4.44%）,死亡5例（3.70%）。6例胰漏患者中死亡1例,经二次手术治疗痊愈1例,其余经保守治疗痊愈。手术方式（切除范围）、胰管吻后方式、胰管支架放置方式、手术时间与胰漏发生无明确关系（P均〉0.05）。术中出血量〉1 000 mL可增加胰漏发生率（P〈0.05）;早期肠内营养支持及生长抑素的应用可预防胰漏的发生。结论胰十二指肠切除术术后胰漏发生与术中技术因素及术后一些积极的处理措施有明显关系。精湛的手术技巧和术后处理措施的合理采用是预防或减少术后胰漏发生的重要手段。

The Correlation between Pancreatic Leakage and Associated-therapeutic Factors after Pancreaticoduodenectomy

Objective To explore the correlation between the occurrence of pancreatic leakage and the different clinical treatment measures given after pancreaticoduodenectomy.Methods The cases with PD from Jun.2002 to Oct.2007 were retrospectively reviewed.Results Of the 135 patients undergoing pancreaticoduodenectomy,overall operative mortality was 3.7% and pancreatic leakage was 4.44%.The patients with pancreatic leakage were treated conservatively,except for one died of pancreatic leakage and one cured by operation again.Statistics analysis indicated:the surgery way(excision scope),the digestive tract reconstruction type(pancreas intestines tally way),the ductus pancreaticus support laying aside way,the surgery time and the Posteperative pancreatic leakage did not show any explicit relations(P>0.05);The volume of bleeding >1 000 mL increased the postoperative pancreatic leakage rate(P<0.05);After the technique,grows in the chalone,the early intestines the nutrition support and the growth chalone application prevented the occurrence of postoperative pancreatic leakage.Conclusion There is the correlation between occurrence of pancreatic leakage and the different clinical treatment measures given intraoperative and postoperative.The exquisitely surgical technique intraoperative and rationally adoption of treatment measures postoperative are important for preventing or reducing the occurrence of pancreatic leakage that.