胰十二指肠切除术近期合并症及技术改进

目的:探讨如何提高壶腹周围肿瘤的切除率以及降低胰十二指肠切除术后的主要并发症-胰漏的发生.方法:1995年3月～2000年12月本院行胰十二指肠术126例,除经典的手术步骤,作者对手术方法进行了改进,完整切除胰腺钩突,在门静脉与胰头粘连时应仔细分离,受到浸润时可合并门静脉侧壁或部分切除,胰肠端侧吻合时,将胰腺残端确切地套入空肠,并在吻合口两角危险区及前壁覆盖一束大网膜.结果:胰十二肠切除技术的改进,提高了切除率和生存率,而且并发症并未增加,本组患者1、3年生存率分别为71.4%、48.6%;胰肠端端吻合胰漏的发生率为4.8%,端侧吻合加吻合口周围附以带蒂大网膜无胰漏发生.结论:随着外科学的进步,胰十二指肠切除及合并门静脉部分切除已是安全有效的手术方式,胰肠端侧吻合加吻合口周围覆盖大网膜能有效地避免胰漏的发生.

Early Complication and Technical Improvement of Pancreatoduodenectomy

Objective: To explore how to pull up resected rate of peri-ampullar tumor and decrease complication of pancreatoduodenectomy-pancreatic fistula. Methods: 126 patients underwent pancreatoduodenectomy were restrospectively reviewed from March 1995 to December 2000 in our hospital. Results: Improvement of pancreatoduodenectomy increased the resected rate and survival rate, but the complication was not increased. Survival rato of 1, 3 years were 71.4%,48.6% respectively. Incidence rate of pancreatic fistula after pancreaticojejunostomy with end-to-end was 4.8%, and there was no incidence of pancreatic fistula when the anastomotic stoma of pancreaticojejunostomy with end-to-side was covered by pedunculated greater omentum. Conclusion: Pancreatoduodenectory with radical resection of portal vein could be performed safely. Pancreaticojejunostomy(end-to-side) with the anastomotic stoma covered with greater omentum could avoid effectively incidence of pancreatic fistula.