胰十二指肠切除术后胰肠吻合口瘘临床分析

目的：回顾分析胰十二指肠切除术后发生胰肠吻合口瘘病例以减少手术并发症。方法：对1986年1月－2001年6月62例胰十二指肠切除术病例资料行回顾性分析。结果：62例中，发生胰肠吻合口瘘9例，发生率14．5％，其中1986年1月－1991年12月发生胰肠吻合口瘘5例，发生率62．5％（5／8）；1992年1月－2001年6月发生胰肠吻合口瘘4例，发生率7．4％（4／54）。围手术期死亡2例，死亡率3．2％，占胰瘘的22．2％。死因为胰瘘致全身衰竭。结论：要降低胰肠吻合口瘘的发生率，重点在于手术技巧及方式的改进。手术前后的支持治疗、应用生长抑制、控制感染、有效的胃肠减压是必须的。一旦发生胰瘘，若早期诊断，及时采取综合治疗，可以使绝大部分的胰肠吻合口瘘得到治愈。

Clinical analysis of pancreatic fistula after pancreaticoduodenectomy

Objective To summarize the experience and to lower operative morbidity through analyzing the cases of pancreatic fistula after pancreaticoduodenectomy from Jan. 1986 to Juen 2001. Methods Data of 62 cases of pancreaticoduodenectomy from Jan. 1986 to June 2001 were retrospectively analyzed. Results Of the 62 cases undergoing pancreaticoduodenectomy, pancreatic fistula occurred in 9 cases with a morbidity rate of 14. 5%. In 5 of the 8 cases (62. 5%). Pancreatic fistula occurred between Jan. 1986 and Dec. 1991, and in 6 of the remaining 54 cases (7. 4%) between Jan. 1992 and June 2001. Two patients (3. 2%) died in perioperation because of pancreatis fistula leading to systemic failure. The overall morbidity of pancrteatic fistula was 22.2%. Conclusions To lower the morbidity of pancreatic fistula, the key lies in improving the operative skill and mode in addtion to pre- and postoperative supporting therapy, use of somatostatin, control of infection and effective gastrointestinal decompression. Most pancreatic fistulas can be cured by early diagnosis and combined therapy.