• 中國醫(yī)科大學(xué)盛京醫(yī)院肝膽胰腫瘤病房(沈陽110004);

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,沒有胰管梗阻和脫落的跡象?;颊邲]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). 中國普外基礎(chǔ)與臨床雜志, 2009, 16(1): 66-67. doi: 復(fù)制

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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. 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. 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. 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. 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. 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. 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. 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] . 中國普外基礎(chǔ)與臨床雜志, 2002; 9(3):215.
  8. 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. 9. Aranha GV, Aaron JM, Shoup M, et al . Current management of pancreatic, fistula after pancreaticoduodenectomy [J] . Surgery, 2006; 140(4): 561.
  10. 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. 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] . 中國普外基礎(chǔ)與臨床雜志, 2003; 10(6): 550.
  12. 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. 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.