胰十二指肠切除术87例临床分析

目的　探讨胰十二指肠切除术指征 ,提高手术切除率及减少术后并发症的发生。方法　回顾性总结 1990～ 2 0 0 2年 8月间我院收治的 87例胰十二指肠切除术病例的临床资料 ,采用联合定性法和经十二指肠胰腺穿刺组织学检查提高诊断率。逆向胰腺切断 ,血管修补提高切除率。单层套入式胰十二指肠切除术胰肠重建。术前“减黄”等措施减少手术并发症。结果　 87例中 ,术后出现胰瘘 1例 ,胆瘘 2例 ,胃肠吻合口瘘 1例。住院期间死亡 3例。重度梗阻性黄疸术后并发症的发生率明显增高。结论　可能的诊断及合适的探查和适应证范围的扩大能提高手术切除率。术前“减黄”、单纯套入式胰肠吻合等正确手术操作 ,是降低术后并发症发生率的有效方法

Clinical analysis of 87 cases of pancreaticoduodenectomy

Objective To investigate the indications for pancreaticoduodenectomy so as to increase the resective rate and reduce the postoperative complications.Methods Clinical data of 87 cases of pancreticoduodenectomy performed from 1990 to Aug. 2002 were retrospectively analyzed. A combinative way to determine the nature and pancreas puncture through duodenum were applied to increase the correct rate of diagnosis. Converse cutting off of pancreas and blood vessel repair were performed to raise resective rate. Pancreticointstine was reconstructed by inserting intestine and monolayer suture. Measures such as minus jaundice before operation was used to reduce the postoperative complications. Among the 87 cases, 1( 1.2 %) suffered from pancreatic fistula, 2( 5.8 %) from cholefistula, 1 ( 1.2 %) from gastrointestinal anastomotic leakage. Three cases ( 3.5 %) died in hospital. Postoperative complications in the patients with serious obstructive jaundice were markedly increased.Conclusion Potential diagnosis and appropriate exploration and indications extended can improve resective rate. Preoperative minus jaundice and correct operative procedures such as inserting into intestine and monolayer suture may be an effective way to reduce operative complications.