胰十二指肠切除术后胰瘘的高危因素分析及防治对策

李俊杰; 李霄; 岳树强

胰十二指肠切除术后胰瘘的高危因素分析及防治对策

第四军医大学西京医院肝胆胰脾外科

详细信息

中图分类号: R657.5
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出版历程
- 收稿日期: 2011-06-13
- 出版日期: 2011-11-20

Analysis of high risks of postoperative pancreaticojejunostomy leakage and its treatment

摘要

摘要: 胰肠吻合口瘘(胰瘘)是胰十二指肠切除术后常见的并发症,易引起术后感染和出血,导致二次手术治疗甚至死亡。与胰瘘发生相关的高危因素很多,可分为患者全身因素、疾病相关因素和手术相关因素三个方面。预防并控制胰瘘的发生,进一步降低胰十二指肠切除术后病死率,是普外科医师面临的巨大挑战。本文试就胰肠吻合口瘘相关的高危因素和处理对策进行分析和综述,希望对胰腺外科的临床工作有所帮助。
- 胰腺瘘 /
- 胰十二指肠切除术
Abstract: Pancreaticojejunostomy leakage (PL) is one of the most common complications of pancreatoduodenectomy, which can cause postoperative infection, hemorrhage, reoperation and even death.There are many high risks of PL, including systemic factors, disease factors and operative factors.Prevention of PL, and reducing mortality after pancreatoduodenectomy is a great challenge for general surgeons.This review summarizes the analysis of the high risks of PL and its treatment, hoping to make a contribution to clinical work.
- pancreatic fistula /
- pancreatoduodenectomy

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参考文献(39)

[1]Halsted WS.Contributions to the surgery of the bile passa-ges, especially of the common bile duct[J].Boston MedSurg J, 1899, 141:645-654.

[2]Kaush W.Das carcinom der papilla duodeni and seine radikaleentfernung[J].Beitrage zur Klinishen Chirurgie, 1912, 78:29-33.

[3]Whipple AO, Parsons WB, Mullins CR.Treatment of carci-noma of the ampulla of Vater[J].Ann Surg, 1935, 102 (4) :763-779.

[4]Bassi C, Dervenis C, Butturini G, et al.International studygroup on pancreatic fistula Definition.Postoperative pancre-atic fistula:an international study group (ISGPF) definition[J].Surgery, 2005, 138 (1) :8-13.

[5]Akamatsu N, Sugawara Y, Komagome M, et al.Risk factorsfor postoperative pancreatic fistula after pancreaticoduode-nectomy:the significance of the ratio of the main pancreaticduct to the pancreas body as a predictor of leakage[J].JHepatobiliary Pancreat Sci, 2010, 17 (3) :322-328.

[6]Wande B, Mark P, Charles M.Risk prediction for develop-ment of pancreatic fistula using the ISGPF classificationscheme[J].WorldJ Surg, 2008, 32 (3) :419-428.

[7]Butturini G, Daskalaki D, Molinari E, et al.Pancreatic fistula:definition and current problems[J].J Hepatobiliary Pancre-at Surg, 2008, 15 (3) :247-251.

[8]窦科峰, 季茹.胰腺术后胰瘘的相关进展[J].国际外科学杂志, 2009, 36 (9) :580-582.

[9]Lin JW, Cameron JL, Yeo CJ, et al.Risk factors and out-comes in post pancreaticoduodenecto-my pancreaticocutaneous fistula[J].Gastrointest Surg, 2004, 8 (8) :951-959.

[10]Munoz-Bongrand N, Sauvanet A, Denys A, et al.Conser-vative management of pancreatic fistula after panereaticoduo-denectomy with pancreaticogastrostomy[J].J Am CollSurg, 2004, 199 (2) :198-203.

[11]Shyr YM, Su CH, Wu CW, et al.Does drainage fluid amyl-ase reflect pancreatic leakage after pancreaticoduodenecto-my?[J].World J Surg, 2003, 27 (5) :606-610.

[12]Choe YM, Lee KY, Oh CA, et al.Risk factors affecting pan-creatic fistulas after pancreaticoduodenectomy[J].World JGastroenterol, 2008, 14 (45) :6970-6974.

[13]彭淑牖, 刘颖斌.胰十二指肠切除术胰肠吻合口漏的防治措施[J].临床外科杂志, 2004, 12 (4) :199-200.

[14]Murakami Y, Uemura K, Hayasidani Y, et al.A soft pancre-atic remnant is associated with increased drain fluid pancreat-ic amylase and serum CRP levels following pancreatoduode-nectomy[J].J Gastrointest Surg, 2008, 12 (1) :51-56.

[15]Lermite E, Pessaux P, Brehant O, et al.Risk factors of pan-creatic fistula and delayed gastric emptying after pancreati-coduodenectomy with pancreaticogastrostomy[J].J AmColl Surg, 2007, 204 (4) :588-596.

[16]Aranha GV, Aaron JM, Shoup M, et al.Current manage-ment of pancreatic?stula after pancreaticoduodenectomy[J].Surgery, 2006, 140 (4) :561-568.

[17]Kazanjian KK, Hines OJ, Eibl G, et al.Management of pan-creatic fistulas after pancreatico-duodenectomy:results in437 consecutive patients[J].Arch Surg, 2005, 140 (9) :854-856.

[18]Hoffman J.Does prior adjuvant chemoradiotherapy lead to asafer pancreatoduodenectomy?[J].Ann Surg Oncol, 2006, 13 (1) :7-9.

[19]Kang CM, Kim KS, Choi JS, et al.Persona〗experience ofpancreasre reconstruction following pancreaticoduodenecto-my[J].ANZ J Surg, 2006, 76 (5) :339-342.

[20]Lee SE, Yang SH, Jang JY, et al.Pancreatic fistula afterpancreaticoduodenectomy:a comparison between the twopancreaticojejunostomy methods for approximating the pan-creatic parenchyma to the jejunal seromuscular layer:inter-rupted vs continuous stitches[J].World J Gastroenterol, 2007, 13 (40) :5351-5356.

[21]Peng SY, Wang JW, Lau WY, et al.Conventional versusbinding pancreaticojejunostomy after pancreaticoduodenecto-my:a prospective randomized trial[J].Ann Surg, 2007, 245 (5) :692-698.

[22]Bassi C, Falconi M, Molinari E, et al.Duct-to-mucosaversus end-to-side pancreaticojejunost-omy reconstruc-tion after pancreaticoduodenectomy:results of a prospectiverandomized trial[J].Surgery, 2003, 134 (5) :766-771.

[23]Peng SY, Wang JW, Lau WY, et al.Conventional versusbinding pancreaticojejunostomy after pancreaticoduodenecto-my:a prospective randomized trial[J].Ann Surg, 2007, 245 (5) :692-698.

[24]Peng SY, Mou YP, Liu YB, et al.Binding pancreaticojejunostomy:150 consecutive cases without leakage[J].JGastrointest Surg, 2003, 7 (7) :898-900.

[25]岳树强, 杨雁灵, 帝振宇, 等.降落伞式胰管空肠吻合和胆肠吻合在胰十二指肠切除术的应用体会[J].临床外科杂志, 2009, 17 (2) :85-87.

[26]Yeo CJ, Cameron JY, Maher MM, et al.A prospective ran-domized trial of pancreaticogastos-tomy versus panceatico-jejunostomy after pancreaticoduodenectomy[J].Ann Surg, 1955, 222 (4) :580-592.

[27]Rosemurgy AS, Bloomston M, Serafini FM, et al.Frequen-cy with which surgeons pancreati-coduodenect omy deter-mines length of stay, hospital charges, and in-hospital mor-tality[J].J Gastrointtest Surg, 2001, 5 (1) :21-26.

[28]杨雁灵, 徐小平, 昊国强, 等.改良Child胰肠吻合预防胰漏发生[J].临床外科杂志, 2008, 16 (3) :176-178.

[29]Poon RT, Fan ST, Lo CM, et al.External drainage of pancre-atic duct with a stent to reduce leakage rate of pancreaticoje-junostomy after pancreaticoduodenectomy:a prospectiverandomized trial[J].Ann Surg, 2007, 246 (3) :425-433.

[30]Imaizumi T, Hatori T, Tobita K, et al.Pancreaticojejunosto-my using duct-to-mucosa anastomosis without a stentingtube[J].J Hepatobiliary Pancreat Surg, 2006, 13 (3) :194-201.

[31]Winter JM, Cameron JL, Campbell KA, et al.Does pancre-atic duct stenting decrease the rate of pancreatic fistula fol-lowing pancreaticoduodenectomy?Results of a prospectiverandomized trial[J].J Gastrointest Surg, 2006, 10 (9) :1280-1290.

[32]Khan AW, Agarwal AK, Davidson BR.Isolated Roux Loopduct-to-mucosa pancreaticojejun-ostomy avoids pancre-atic leaks in pancreaticoduodenectomy[J].Dig Surg, 2002, 19 (3) :199-204.

[33]Sutton CD, Garcea G, White SA, et al.Isolated Roux-looppancreaticojejunostomy:a series of 61 patients with zeropostoperative pancreaticoenteric leaks[J].J GastrointestSurg, 2004, 8 (6) :701-705.

[34]Kaman L, Sanyal S, Behera A, et al.Isolated roux loop pan-creaticojejunostomy vs single loop pancreaticojejunostomyafter pancreaticoduodenectomy[J].Int J Surg, 2008, 6 (4) :306-310.

[35]Lai EC, Lau SH, Lau WY.Measures to prevent pancreaticfistula after pancreatoduodenecto-my:a comprehensivereview[J].Arch Surg, 2009, 144 (11) :1074-1080.

[36]Connor S, Alexakis N, Garden OJ, et al.Metaanalysis of thevalue of somatostatin and its analogues in reducing complica-tions associated with pancreatic surgery[J].Br J Surg, 2005, 92 (9) :1059-1067.

[37]Alghamdi AA, Jawas AM, Hart RS.Use of octreotide for theprevention of pancreatic fistula after elective pancreatic sur-gery:a systematic review and meta-analysis[J].Can JSurg, 2007, 50 (6) :459-466.

[38]Nagakawa Y, Tsuchida A, Saito H, et al.The VIO soft coag-ulation system can prevent pancreatic fistula following pan-createctom[J].J Hepatobiliary Pancreat Surg, 2008, 15 (4) :359-365.

[39]Okano K, Kakinoki K, Yachida S, et al.A simple and safepancreastransection using a stapling device for a distal pan-createctomy[J].J Hepatobiliary Pancreat Surg, 2008, 15 (4) :353-358.

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