胰腺术后乳糜瘘的处理

<正>乳糜瘘是胰腺手术后的并发症之一,主要由于区域淋巴循环途径被破坏导致淋巴液外漏。如果淋巴液中甘油三酯含量明显升高,则清亮的淋巴液可表现为乳糜样的白色液体,称为乳糜瘘。中华医学会外科学分会胰腺外科学组将术后乳糜瘘定义为:     

电视胸腔镜术后血胸再次手术止血11例分析

1995年1月至2004年6月．笔者共完成电视胸腔镜手术1927例．其中11例因术后出血再次行止血手术。本文就这11例作一回顾性分析。     

胰腺手术肠系膜上血管损伤大出血的处理

1临床病例例1，女，55岁，上腹剧痛伴恶心呕吐13天，B超示胆囊结石，以“胆囊结石，胆绞痛”剖腹探查发现胰腺及周围组织严重出血水肿，大量皂化斑块，胰腺坏死呈褐色，腹腔血性渗液。切开胰腺被膜，清理坏死胰腺组织，游离胰腺周围，至胰腺下缘肠系膜上血管处时，因水肿严重，解剖不清，撕裂肠系膜上静脉，出血汹涌，辨认不清出血部位，多次试行钳夹止血均未能奏效。此时病人血压在0～4蜘a之间，难以回升，出血部位难以修补，又不能行大块组织缝扎，于是折叠3块干纱布垫，填塞压迫出血处，其上覆以游离大网膜组织，于脊柱两侧筋膜及后腹膜…     

术中肝脾渗血的止血方法

外科手术时,手术操作引起的肝脾损伤性出血十分常见。对于这类出血的处理有时十分困难,常用止血方法有电凝、缝扎、切除脏器等。电凝止血因凝血块脱落,有时止血效果不可靠。缝扎也因肝脾组织十分娇嫩、组织水肿等原因,经常出现针眼渗血、缝线切割,导致越缝越出血。现在很多新型     

胰腺围手术期的处理

本文阐述了腺胰癌及急性出血坏死性胰腺炎围手术期的处理方法。胆道减压引流是严重阻塞性黄疸的术前重要措施之一。细心、耐心地加强急性出血坏死性胰腺炎围手术期处理是减少病死率和并发症重要措施。     

胰腺损伤的手术处理

胰腺因其位于后腹膜及有脊柱的保护,损伤机会较少,约占腹部外伤的1%~10%。近年由于交通工具及现代化工业的迅速发展,胰腺损伤有明显增加的趋势。因解剖和功能复杂,胰腺损伤的死亡率达14%~31%,并发症率为19%~55%,而闭合性胰腺损伤漏诊率达25%~30%。胰腺一旦受损,常会合并其他脏器和血管损伤。正确地应用合适的手术方式处理胰腺损伤,对减少伤者死亡率及术后腹腔出血、胰瘘、肠漏、假性胰腺囊肿、糖尿病、胰腺炎及腹腔脓肿等并发症发生率,有着重要意义。一、胰腺损伤的分级胰腺损伤程度分级有几种方法:Lucas分级、Booth-Plint分级、Moor分级…     

胰腺手术病人术后血糖变化及其意义

目的探讨胰腺手术对病人术后空腹血糖的影响。方法对1994年6月至2004年6月收治的339例外科胰腺手术病人术前、术后空腹血糖的变化进行对照研究。结果胰腺手术的病人术后早期空腹血糖水平明显升高。应用胰岛素可以控制术后早期高血糖。随着术后时间的延长，术后空腹血糖水平逐渐趋于正常。结论胰腺手术可引起病人术后早期高血糖，须应用胰岛素以纠正术后高血糖。一般的胰腺手术不会破坏胰腺内分泌功能，导致病人出现糖尿病。     

胰腺手术主要并发症的处理

胰腺手术主要并发症的处理袁祖荣张圣道由于胰腺解剖、生理特点的特殊性，当它产生疾病时（不管是肿瘤还是坏死感染），常常需要采用手术治疗，而且术后常常会产生一些致命的并发症，如术后大出血、胰肠吻合口瘘、残余感染等等，如不及时处理或处理不当均可导致病人不良后...     

电视胸腔镜术后出血再次手术止血11例分析

1995年1月至2004年6月,我们共完成电视胸腔镜手术1927例。因术后出血,再次行止血手术11例。现报告如下。临床资料本组11例,男7例,女4例,年龄21~60岁。肺大疱5例,食管癌1例,胸腔积液伴纤维板形成4例,外伤性血气胸1例。出血量大于2000ml2例,1000~2000ml8例,500~1000ml1例。术中发现胸腔内积血或血凝块500~1500ml。临床表现为:心率增快伴血压下降4例,呼吸困难5例,患侧呼吸音减弱9例,胸片提示胸腔积液7例。出血部位:肋间动脉出血3例,胸腔渗血4例,未见明显出血1例,ENDO-GIA切割后出血1例,钛夹脱落出血2例。再次手术时间为术后4~48h(平均18h),…     

胰腺微创手术中胰腺残端处理

胰十二指肠切除术(pancreaticoduodenectomy,PD)及胰体尾切除术(distal pancreatectomy,DP)是治疗壶腹周围肿瘤及胰体尾肿瘤的标准术式.此类术式区域解剖复杂,手术操作难度大,术后并发症较多.随着手术经验的积累及围术期管理水平的提高,围术期死亡率已明显下降,但术后并发症发生率仍...     

Therapeutic Management of Hemorrhage from Visceral Artery Pseudoaneurysms after Pancreatic Surgery

Introduction  

Hemorrhage from pseudoaneurysms after pancreatic surgery is a rare but life-threatening and complicated complication. The study presents our experience to provide therapeutic management for this rare condition.     

Surgery of Resectable Nonfunctioning Neuroendocrine Pancreatic Tumors

Nonfunctioning neuroendocrine pancreatic tumors (NFNEPTs) comprise about one-third of pancreatic endocrine tumors. Based on immunohistochemistry, nonfunctioning tumors are difficult to distinguish from functioning ones; therefore the final diagnosis is basically the result of a synopsis of pathology and clinical data. Owing to their incapacity to produce hormone-dependent symptoms, NFNEPTs are detected incidentally or because of uncharacteristic symptoms resulting from local or distant growth. About two-thirds of NFNEPTs are located in the pancreatic head, so jaundice may be a late symptom of this tumor. Modern diagnostic procedures are best applied by a stepwise approach: first endoscopic ultrasonography and computed tomography/magnetic resonance imaging followed by somatostatin receptor scintigraphy or positron emission tomography (or both). Due to significant false-positive and false-negative findings, for decision-making the latter should be confirmed by a second imaging modality. Regarding indications for surgery and the surgical approach to the pancreas, three pancreatic manifestations of NFNEPTs can be distinguished: (1) solitary benign non-multiple endocrine neoplasia type 1 (non-MEN-1); (2) multiple benign MEN-1; and (3) malignant NFNEPTs. Reviewing the literature and including our experience with 18 NFNEPTs (8 benign, 10 malignant) reported here, the following conclusions can be drawn: (1) Solitary benign non-MEN-1 NFNEPTs can be removed by enucleation or by pancreas-, spleen-, and duodenum-preserving techniques in most cases. The choice of surgical technique depends on the location and site of the tumor and its anatomic relation to the pancreatic duct. (2) With multiple benign MEN-1 NFNEPTs, because of the characteristics of the underlying disease a preferred, more conservative concept (removal of only macrolesions) competes with a more radical procedure (left pancreatic resection with enucleation of head macrolesions). Further studies are necessary to clarify the best way to balance quality of life (by preserving organ function) with growth control of potentially malignant tumors in the pancreas. (3) Malignant NFNEPTs comprise more than half of all NFNEPTs. Few studies have analyzed treatment strategies for localized or metastatic tumors. Whereas radical (including multivisceral) resection of tumors without distant metastases is widely accepted, the indication for radical surgery on metastasizing tumors has been questioned, as radical removal of the primary tumor may fail to increase survival. Adjuvant regimens in these tumor stages are mandatory and should be further optimized.