目的 探討胰十二指腸切除術(shù)后胰瘺引起腹腔大出血行外科治療的可行性。
方法 在343例行胰十二指腸切除術(shù)的患者中，2例術(shù)后發(fā)生嚴(yán)重的胰瘺伴有腹腔大出血，均再次手術(shù)行胰腸分離式橋式內(nèi)引流術(shù)。
結(jié)果 經(jīng)術(shù)后支持治療、持續(xù)腹腔沖洗、抑制胰酶分泌，治療成功，順利出院。術(shù)后隨訪18個(gè)月，沒(méi)有胰管梗阻和脫落的跡象?；颊邲](méi)有發(fā)生糖尿病。
結(jié)論 胰十二指腸切除術(shù)后胰瘺導(dǎo)致的腹腔大出血治療非常困難，通過(guò)外科再手術(shù)行胰腸分離式橋式內(nèi)引流術(shù)，取得成功，避免了復(fù)雜的全胰切除，挽救了胰腺功能，提高了患者的成功救治機(jī)會(huì)，改善了患者術(shù)后的生活質(zhì)量。
引用本文： 徐進(jìn),卜獻(xiàn)民,戴顯偉. 胰十二指腸切除術(shù)后胰瘺致腹腔大出血再手術(shù)治療體會(huì)（附2例報(bào)道）. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 16(1): 66-67. doi: 復(fù)制
| 1. | 沈魁， 鐘守先， 張圣道主編. 胰腺外科 [M] . 第1版. 北京： 人民衛(wèi)生出版社， 2000：399～402. |
| 2. | Allema JH, Reinders ME, van Gulik TM, et al . Results of pancreaticoduodenectomy for ampullary carcinoma and analysis of prognostic factors for survival [Ｊ] . Surgery, 1995; 117(3) ∶247. |
| 3. | Yeo CJ, Cameron JL, Sohn TA, et al . Six hundred fifty consecutive pancreatico-duodenectomies in the 1990s: pathology, complications, and outcomes [Ｊ] . Ann Surg, 1997; 226(3) ∶248. |
| 4. | van Berge Henegouwen MI, Allema JH, van Gulik TM, et al . Delayed massive haemorrhage after pancreatic and biliary surgery [Ｊ] . Br J Surg, 1995; 82(11)：1527. |
| 5. | Tien YW, Lee PH, Yang CY, et al . Risk factors of massive bleeding related to pancreatic leak after pancreaticoduodenectomy [Ｊ] . J Am Coll Surg, 2005; 201(4)：554. |
| 6. | de Castro SM, Kuhlmann KF, Busch OR, et al . Delayed massive hemorrhage after pancreatic and biliary surgery: embolization or surgery? [Ｊ] . Ann Surg, 2005; 241(1)：85. |
| 7. | 劉穎斌， 白明東， 彭淑牖， 等. 胰十二指腸切除術(shù)后胰瘺的防治近況 [Ｊ] . 中國(guó)普外基礎(chǔ)與臨床雜志， 2002； 9（3）：215. |
| 8. | Gueroult S, Parc Y, Duron F, et al . Completion pancreatectomy for postoperative peritonitis after pancreaticoduodenectomy: early and late outcome [Ｊ] . Arch Surg, 2004; 139(1)：16. |
| 9. | Aranha GV, Aaron JM, Shoup M, et al . Current management of pancreatic, fistula after pancreaticoduodenectomy [Ｊ] . Surgery, 2006; 140(4)： 561. |
| 10. | Shyr YM, Su CH, Wu CW, et al . Does drainage fluid amylase reflect pancreatic leakage after pancreaticoduodenectomy? [Ｊ] . World J Surg, 2003; 27(5)： 606. |
| 11. | 華赟鵬， 賴佳明， 梁力建. 胰十二指腸切除術(shù)后出血39例臨床分析 [Ｊ] . 中國(guó)普外基礎(chǔ)與臨床雜志， 2003； 10(6)： 550. |
| 12. | Yekebas EF, Wolfram L, Cataldegirmen G, et al . Postpancreatectomy hemorrhage: diagnosis and treatment: an analysis in 1 669 consecutive pancreatic resections [Ｊ] . Ann Surg, 2007; 246(2)：269. |
| 13. | Tamijmarane A, Ahmed I, Bhati CS, et al . Role of completion pancreatectomy as a damage control option for post-pancreatic surgical complications [Ｊ] . Dig Surg, 2006; 23(4)： 229. |
- 1. 沈魁， 鐘守先， 張圣道主編. 胰腺外科 [M] . 第1版. 北京： 人民衛(wèi)生出版社， 2000：399～402.
- 2. Allema JH, Reinders ME, van Gulik TM, et al . Results of pancreaticoduodenectomy for ampullary carcinoma and analysis of prognostic factors for survival [Ｊ] . Surgery, 1995; 117(3) ∶247.
- 3. Yeo CJ, Cameron JL, Sohn TA, et al . Six hundred fifty consecutive pancreatico-duodenectomies in the 1990s: pathology, complications, and outcomes [Ｊ] . Ann Surg, 1997; 226(3) ∶248.
- 4. van Berge Henegouwen MI, Allema JH, van Gulik TM, et al . Delayed massive haemorrhage after pancreatic and biliary surgery [Ｊ] . Br J Surg, 1995; 82(11)：1527.
- 5. Tien YW, Lee PH, Yang CY, et al . Risk factors of massive bleeding related to pancreatic leak after pancreaticoduodenectomy [Ｊ] . J Am Coll Surg, 2005; 201(4)：554.
- 6. de Castro SM, Kuhlmann KF, Busch OR, et al . Delayed massive hemorrhage after pancreatic and biliary surgery: embolization or surgery? [Ｊ] . Ann Surg, 2005; 241(1)：85.
- 7. 劉穎斌， 白明東， 彭淑牖， 等. 胰十二指腸切除術(shù)后胰瘺的防治近況 [Ｊ] . 中國(guó)普外基礎(chǔ)與臨床雜志， 2002； 9（3）：215.
- 8. Gueroult S, Parc Y, Duron F, et al . Completion pancreatectomy for postoperative peritonitis after pancreaticoduodenectomy: early and late outcome [Ｊ] . Arch Surg, 2004; 139(1)：16.
- 9. Aranha GV, Aaron JM, Shoup M, et al . Current management of pancreatic, fistula after pancreaticoduodenectomy [Ｊ] . Surgery, 2006; 140(4)： 561.
- 10. Shyr YM, Su CH, Wu CW, et al . Does drainage fluid amylase reflect pancreatic leakage after pancreaticoduodenectomy? [Ｊ] . World J Surg, 2003; 27(5)： 606.
- 11. 華赟鵬， 賴佳明， 梁力建. 胰十二指腸切除術(shù)后出血39例臨床分析 [Ｊ] . 中國(guó)普外基礎(chǔ)與臨床雜志， 2003； 10(6)： 550.
- 12. Yekebas EF, Wolfram L, Cataldegirmen G, et al . Postpancreatectomy hemorrhage: diagnosis and treatment: an analysis in 1 669 consecutive pancreatic resections [Ｊ] . Ann Surg, 2007; 246(2)：269.
- 13. Tamijmarane A, Ahmed I, Bhati CS, et al . Role of completion pancreatectomy as a damage control option for post-pancreatic surgical complications [Ｊ] . Dig Surg, 2006; 23(4)： 229.