老年患者胃大部切除术后十二指肠残端瘘的预防及诊治体会

【目的】探讨老年患者胃大部分切除术后十二指肠残端瘘的病因、预防及诊治。【方法】回顾性分析本院2000年1月至2010年12月施行的105例胃大部分切除术后发生十二指肠残端瘘的13例老年患者临床资料。【结果】治愈10例，死亡3例。死亡的主要原因是感染性休克和多器官功能障碍综合征。【结论】充分的术前准备是预防胃大部分切除术后十二指肠残端瘘的关键，十二指肠残端瘘发生后要早期行十二指肠造瘘，加强营养支持、合理应用抗生素。

Prevention, Diagnosis and Treatment of Duodenal Stump Leakage in Elderly Patients

Objective] To explore the causes, prevention, diagnosis and treatment of duodenal stump leakage after gastrectomy in elderly patients. Methods]Clinical data of 13 elderly patients with duodenal stump leakage after gastrectomy from Jan. 2000 and Feb. 2010 were analyzed retrospectively. Results] Ten patients were cured successfully and 3 patients died. The main causes of death were septic shock and multiple organ dysfunction syndrome. Conclusion] Sufficient preoperative preparation is the key to prevent duodenal fistula after subtotal gastrectomy. Early duodenostomy should be performed once after the occurrence of duo- denal stump leakage. Nutrition support should be strengthened and antibiotics should be rationally used.