胰十二指肠切除术后胰瘘合并出血二次手术2例并国内文献复习

目的 关于胰十二指肠切除术后胰瘘合并出血的二次手术方式缺乏相应的指南及专家共识,本文旨在复习胰十二指肠切除术后胰瘘合并出血的二次手术方式并探讨胰十二指肠切除术后胰瘘合并出血治疗方案。方法 回顾分析2例胰十二指肠切除术后C级胰瘘合并出血的诊疗及手术过程,对胰十二指肠切除术后胰瘘合并出血的二次手术方式进行文献复习。结果 2例胰十二指肠切除术后C级胰瘘合并出血的患者,均在保守治疗无效的情况下进行了二次手术。患者1在探查胰肠吻合口时,发现门静脉出血,确切止血后重新行原位的胰肠吻合术,最终痊愈出院;患者2由于胰瘘导致了迟发性的出血及腹腔感染,在二次手术时并未发现明确的责任血管,手术中对出血风险较高的血管进行了结扎,并对胰肠吻合口进行了加针修补,最终患者因全身多器官功能衰竭死亡。结论 PD术后胰瘘合并出血的治疗需要介入科、重症医学科、普外科的多学科参与,外科手术仍然是PD术后胰瘘合并出血的关键一环。

Two cases report of reoperation for pancreatic fistula complicated with hemorrhage after pancreatoduodenectomy and literature review

Objective This article aim was to review the relaparotomy methods and to discuss the treatment scheme of severe pancreatic fistula with hemorrhage.Methods The diagnosis,treatment and relaparotomy process of two cases of grade C pancreatic fistula complicated withhemorrhage after pancreaticoduodenectomy were retrospectively analyzed,and the reoperation methods of pancreatic fistula complicated with hemorrhage after pancreaticoduodenectomy were reviewed.Results Two patients with grade C pancreatic fistula complicated with hemorrhage underwent the rescue resection.The first patient was found portal vein bleeding when explored the pancreaticointestinal anastomosis.After stopping bleeding,we underwent in-situ pancreaticojejunostomy.The first patient finally recovered.The second patient suffered from delayed hemorrhage and abdominal infection due to pancreatic fistula.No clear responsible blood vessels were found during the reoperation process.The blood vessels with high risk of bleeding were ligated during the relaparotomy,and the Pancreaticointestinal anastomosis was repaired.Eventually,the patient died of multiple systematic organ failure(MSOF).Conclusion The treatment of pancreatic fistula complicated with.Hemorrhage after PD often requires multidisciplinary participation of interventional department,ICU and surgical department.Surgery still playthe important role in pancreatic fistula complicated with hemorrhage after PD.