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。

RISK FACTORS OF COMPLICATIONS FOLLOWING PANCREATODUDENECTOMY IN PANCREATIC CANCER

Objective To evaluate the risk factors of complications after pancreaticoduodenectomy(PD) and the role of duct-to-mucosa pancreaticojejunostomy in prevention of complications of PD in pancreatic cancer.Methods A total of 138 patients who underwent PD between January 1996 and December 2006 were retrospectively reviewed.All patients were pathologically diagnosed as pancreas cancer or ampullary cancer.Standard PD was performed in 138 patients,including PD with pylorus-preserving PD in 6 patients.A duct-to-mucosa pancreaticojejunostomy was performed in patients with a dilated pancreatic duct,and conventional end-to-end invagination pancreaticojejunostomy in patients with normal or small pancreatic duct.Patients were classified into pancreatic leakage and non-pancreatic leakage.Potential risk factors of complications after pancreatic surgery were statistically studied.Results Of the 138 patients underwent duct-to-mucosa pancreaticojejunostomy,32(23.18%) had pancreatic leakage after operation.Other postoperative complications included delayed gastric emptying in 3 patients,abdominal bleeding in 9 patients(6.5%),and wound infection in 3 patients.The overall surgical morbidity was 40.57%(56/138).One patient died from pancreatic leakage and abdominal following operation in hospital.Risk factors of complications in PD consisted of age,gender,length of jaundice,preoperative nutrition,pathological pattern of pancreatic cancer and operative time.There was no statistical difference in the incidence of pancreatic leakage in considering of these risks factors.The incidence of pancreatic leakage was 22.48%(29/129) in patients with duct-to-mucosa anastomosis,and was 33.33%(3/9) in those with conventional invagination anastomosis,and no statistical significance was found(P=0.7358).This might be due to the small number of patients with conventional invagination anastomosis.The incidence of pancreatic leakage in patients with PPPD had no significant difference with that in patients with PD(P=0.313).However,the incidence of delayed gastric emptying in patients with PPPD was significantly higher than that in patients with PD(P<0.01).Conclusions The mode of pancreaticojejunostomy and whether preserving the pylorus during the PD are not associated with incidence of pancreatic leakage after PD significantly,preserving the pylorus might increase the chance of delayed gastric emptying;careful manipulation of equipment of gastrointestinal anastomosis may be helpful in reducing the incidence of recent gastrointestinal bleeding after PD.