摘要
目的探讨逆行性经肝胆管引流在预防胰十二指肠切除(PD)术后胰瘘中的应用价值。方法回顾性分析2015年8月至2017年8月62例行逆行性经肝胆管引流PD术的临床资料。采用SPSS 17.0软件包进行统计学分析,逆行性经肝胆管引流的引流量的比较采用配对t检验,P<0.05表示差异有统计学意义。结果 62例PD术患者术中均行逆行性经肝胆管引流术,所有患者均无出血、胆漏等手术并发症;胆管引流量:术后1~4 d(343.17±36.97)ml/d高于术后5~8 d的引流量(183.68±74.94)ml/d,其差异具有统计学意义(P<0.05);术后胰瘘7例,其中A级胰瘘(生化漏)2例;B级胰瘘7例(11.3%);无C级胰瘘。术后胰瘘患者均经保守治疗痊愈出院。结论逆行性经肝胆管引流可以减少PD术后早期胰肠吻合空肠袢淤滞的消化液,降低肠腔压力,降低PD术后胰瘘的发生率,是预防PD术后胰瘘的一种安全手术方式。
Objective To evaluate the clinical application of retrograde percutaneous transhepatic biliary drainage(RPTBD)in the prevention of pancreatic fistula after pancreaticoduodenectomy(PD).Methods The data of 62 cases of RPTBD after PD performed between August 2015 and August 2017 were retrospectively analyzed.The data analyses were performed by using SPSS 17.0 statistics software package.The paired t test was adopted to compare the volumes of RPTBD and the results would be reported as statistically significant as P<0.05. Results 62 cases of PD were successfully performed with RPTBD and all cases experienced no bleeding,biliary leakage.The volume of biliary drainage for 1 to 4 days(343.17±36.97)ml/d after operation was higher than that for 5 to 8 days(183.68±74.94)ml/d,which revealed a statistical significance(P<0.05);7 cases experienced postoperative pancreatic fistula,including 2 cases of grade A(biochemical fistula,3.2%),7 cases of grade B(11.3%)and none of grade C.All the fistula patients were cured by conservative treatment and discharged from hospital. Conclusion RPTBD can be seen as a safe surgical treatment to effectively prevent the pancreatic fistula after PD owing to the reduction of the digestive juice remained in the jejuna loop after the early pancreaticojejunostomy;can decrease the intraluminal pressure and also prevent the pancreatic fistula.
作者
刘翔
张涛
金奎
段伟宏
陈道媛
曲霏
梁彦利
雷蕾
刘军桂
Liu Xiang;Zhang Tao;Jin Kui;Duan Weihong;Chen Daoyuan;Qu Fei;Liang Yanli;Lei Lei;Liu Jungui(Department of Hepatobiliary Surgery,PLA Rocket Force General Hospital,Beijing 100088,China)
出处
《中华普外科手术学杂志（电子版）》
2018年第2期172-174,共3页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
关键词
胰腺瘘
胰十二指肠切除术
引流术
Pancreatic Fistula
Pancreaticoduodenectomy
Drainage
