许　震

减压管不同放置方法对胰十二指肠切除术后胰瘘的临床观察

许震

目的 探讨分析减压管不同放置方法对胰十二指肠切除术后胰瘘发生的影响。方法 选取胰十二指肠切除术患者62例为观察组，术中于胰肠吻合口盲端远端置引流管减压。同期手术患者66例为对照组，术中于主胰管放置引流管减压。对2组患者术后胰瘘及其他并发症发生率进行比较，并随访记录1年复发率及生存率。结果 观察组术后出现胰瘘1例（1.6%），并发症发生总例数为3例（4.8%）；而对照组出现胰瘘8例（12.1%），总计11例（16.7%）。观察组胰瘘及总并发症发生率均低于对照组（P＜0.05），差异有统计学意义。2组1年复发率及生存率差异均无统计学意义（P＞0.05）。结论 胰肠吻合口盲端远端置引流管减压可有效降低胰十二指肠切除术后胰瘘发生率。

胰十二指肠切除术；并发症；胰瘘；减压术

【Abstract】

Objective To investigate the effects of different decompression tube placement methods on pancreatic fistula after pancreaticoduodenectomy. Methods 62 patients treated with pancreaticoduodenectomy were rolled as observation group and underwent decompression by insertion of a drainage tube into the distal part of the blind end of the pancreatic jejunal anastomosis. 66 patients in the same period as control group，and underwent decompression by insertion of a drainage tube into the main pancreatic duct.The incidence of pancreatic fistula，recurrence rate and survival rate between both groups were compared. Results The incidence of pancreatic fistula and total incidence rate was 1.6% and 4.8% in the observation group，and 12.1%，16.7% in the control group，respectively. They had significant difference between 2 groups（P＜0.05）. The recurrence rate and survival rate between both groups were no significant difference（P＞0.05）. Conclusion Drainage tube into the distal part of the blind end of the pancreatic jejunal anastomosis is helpful to reduce the incidence of pancreatic fistula.

作者单位：郑州大学附属洛阳中心医院外科，河南 洛阳 471000

【Key words】Pancreaticoduodenectomy，Complication，Pancreatic fistula，Decompression

胰十二指肠切除术是治疗胰腺癌较为有效的手段之一［1-3］，也是腹部外科较为复杂且创伤较大的手术之一。由于手术时间较长、术中切除组织和器官较多，术后并发症发生率较高［4］。常见并发症主要有胰瘘、出血、腹腔感染、胃排空延迟以及胆瘘等，其中胰瘘是较为严重的并发症［5］。近年来尽管医疗技术获得较大进步，但胰十二指肠切除术后胰瘘的发生率仍居高不下。有效的术后引流减压有助于降低胰瘘的发生率，本文即对不同减压方式在预防胰瘘中的应用价值进行分析。……