防范Whipple术后胰瘘的临床体会

目的 探讨预防胰十二指肠切除术后胰瘘的经验。方法 回顾性总结胰十二指肠切除术42例的临床资料，实施胰空肠端端套入吻合术28例，捆绑式胰肠吻合术14例，全组病人均放置胰管支撑引流，外引流18例，内支架管引流24例，结果 全组无胰瘘发生，术后并发伤口感染2例，胃排空障碍1例，肺部感染1例，胃肠出血1例，腹腔脓肿1例，胆瘘1例，并发症发生率为16.7%，内支撑引流的病人术后恢复明显快于完全外引流的病人。结论 胰管内支撑引流，精细的胰肠吻合和有效的围手术期治疗是预防Whipple术后胰瘘的关键。

EXPERIENCE OF THE PREVENTION OF PANCREATIC FISTULA AFTER PANCREATICODUODENECTOMY

Objective To study the prevention of pancreatic fistula after pancreaticoduodenectom y.Methods A retro- spective analysis was made on4 2 patients with pancreaticoduodenectomy from January1997to February2 0 0 2 .In 4 2 cases a pancreaticojejunostom y was perform ed,2 8in an end- to- end invaginated fashion,and 14 in an end- to- end binding fashion.Re- sults The postoperative morbidity rate was16 .7% (7/ 4 2 ) ,including wound infection in2 cases,residual gastric emptying dysfuntion in1case,pulm onary infection in1case,biliary fistula in1case,intra- abdominal abscess in1case,gastrointestinal bleeding in 1case.Of the 4 2 cases,no postoperative pancreatic fistula occurred and no in- hospital death.Conclusion Pancre- atic duct endoprosthetic stent,delicate pancreaticojejunal anastomosis and effective perioperative management are a key to prevent pancreatic fistula after pancreaticoduodenectom y.