【摘要】：目的：胰十二指腸切除術(shù)(pancreaticoduodenectomy, PD)亦稱Whipple手術(shù)，是治療胰頭癌、壺腹周圍癌的主要方法。PD術(shù)后胰瘺一直是胰腺外科醫(yī)生永恒的話題，而胰瘺也是促進(jìn)PD不斷改進(jìn)、不斷發(fā)展的主要?jiǎng)恿χ�。為了預(yù)防胰瘺，外科醫(yī)生從未停止探索的腳步，從吻合方式、吻合技巧、縫線、生物蛋白膠、胰管支撐管到各種支持藥物的使用等各個(gè)環(huán)節(jié)都在不斷的努力，目的是降低胰瘺及其他術(shù)后相關(guān)并發(fā)癥的發(fā)生率。胰管支撐管應(yīng)用于臨床具有重大的意義，但對于胰管支撐管的內(nèi)引流與外引流何者能更有效的預(yù)防胰瘺，，各醫(yī)學(xué)中心和學(xué)者尚未達(dá)成一致觀點(diǎn)。目前對于胰管支撐管的內(nèi)引流與外引流以何種方式更確切，國內(nèi)外相關(guān)文獻(xiàn)報(bào)道較少。通過分析本組病例資料，比較胰十二指腸切除術(shù)后胰管支撐管的內(nèi)引流與外引流對于術(shù)后胰瘺及其他術(shù)后并發(fā)癥發(fā)生的影響，來探討胰管支撐管的內(nèi)引流與外引流在預(yù)防胰瘺中的價(jià)值。 方法：回顧性分析吉林大學(xué)中日聯(lián)誼醫(yī)院2010年10月至2014年2月期間施行PD的病例資料107例，其中未使用支撐管18例、胰胃吻合5例排除此次研究，納入觀察組共84例，內(nèi)引流49例（58.3%），外引流35例（41.7%）。所有患者均接受PD，并均在胰管內(nèi)置入與其口徑相當(dāng)?shù)闹喂�。分別分析患者術(shù)前指標(biāo)（年齡、性別、黃疸時(shí)間、高血壓、心臟病、糖尿病、總膽紅素、直接膽紅素、間接膽紅素、總蛋白、白蛋白、血紅蛋白測定）、術(shù)中指標(biāo)（疾病組成、吻合方式、胰腺質(zhì)地、胰管直徑）、術(shù)后指標(biāo)（膽瘺、胃腸/腸腸吻合口瘺、消化道內(nèi)出血、肺部并發(fā)癥、切口感染、二次手術(shù)、生長抑素的使用、術(shù)后死亡、住院時(shí)間）的差異，來比較支撐管內(nèi)引流與外引流對于術(shù)后胰瘺的影響。 結(jié)果：患者術(shù)前指標(biāo)（年齡、性別、黃疸時(shí)間、高血壓、心臟病、糖尿病、總膽紅素、直接膽紅素、間接膽紅素、總蛋白、白蛋白、血紅蛋白測定）、術(shù)中情況（疾病組成、胰腺質(zhì)地、胰管直徑、吻合方式）、術(shù)后情況（膽瘺、胃腸/腸腸吻合口瘺、消化道內(nèi)出血、肺部并發(fā)癥、切口感染、二次手術(shù)、生長抑素的使用、術(shù)后死亡、住院時(shí)間）等指標(biāo)均無統(tǒng)計(jì)學(xué)差異。內(nèi)引流組發(fā)生胰瘺12例（24.5%），外引流組發(fā)生胰瘺2例（5.7%），差異有統(tǒng)計(jì)學(xué)意義（P=0.023）。 結(jié)論：胰管支撐管外引流在預(yù)防胰瘺上優(yōu)于內(nèi)引流。
[Abstract]:Objective: pancreaticoduodenectomy (pancreaticoduodenectomy, PD), also known as Whipple's operation, is the main method for the treatment of pancreatic head cancer and periampullary carcinoma. Pancreatic fistula after PD is always an eternal topic for pancreatic surgeons, and pancreatic fistula also promotes the improvement of PD. One of the main driving forces of continuous development. In order to prevent pancreatic fistula, surgeons have never stopped exploring everything from anastomosis, anastomosis techniques, sutures, bioprotein glue, pancreatic duct support tubes to the use of various support drugs. Objective to reduce the incidence of pancreatic fistula and other postoperative complications. The clinical application of pancreatic duct support tube is of great significance, but there is no consensus among medical centers and scholars on which internal and external drainage of pancreatic duct support tube can prevent pancreatic fistula more effectively. At present, there are few reports about the internal and external drainage of the pancreatic duct. By analyzing the data of this group of patients, the effects of internal and external drainage of pancreatic duct supporting tube on pancreatic fistula and other postoperative complications after pancreaticoduodenectomy were compared. To explore the value of internal and external drainage of pancreatic duct supporting duct in preventing pancreatic fistula. Methods: the data of 107 cases of PD from October 2010 to February 2014 in Jilin University Sino-Japanese Friendship Hospital were retrospectively analyzed, including 18 cases without supporting tube, 5 cases with pancreaticogastric anastomosis excluded from the study, and 84 cases in observation group. There were 49 cases (58.3%) with internal drainage and 35 cases (41.7%) with external drainage. All patients received PD, and were placed in the pancreatic duct with a supporting tube equivalent to their caliber. The preoperative indexes (age, sex, time of jaundice, hypertension, heart disease, diabetes mellitus, total bilirubin, direct bilirubin, indirect bilirubin, total protein, albumin, hemoglobin) were analyzed respectively. Anastomosis, pancreatic texture, diameter of pancreatic duct, postoperative parameters (biliary fistula, gastrointestinal / intestinal anastomotic fistula, gastrointestinal bleeding, pulmonary complications, incision infection, secondary surgery, use of somatostatin, postoperative death, To compare the effect of supporting tube drainage and external drainage on postoperative pancreatic fistula. Results: preoperative parameters (age, sex, time of jaundice, hypertension, heart disease, diabetes mellitus, total bilirubin, direct bilirubin, indirect bilirubin, total protein, albumin, hemoglobin), intraoperative condition (disease composition), Pancreatic texture, pancreatic duct diameter, anastomosis mode, postoperative conditions (biliary fistula, gastrointestinal / intestinal anastomotic fistula, gastrointestinal bleeding, pulmonary complications, incision infection, secondary surgery, use of somatostatin, postoperative death, There was no statistical difference in the duration of hospitalization. Pancreatic fistula occurred in 12 cases (24.5%) in the internal drainage group and in 2 cases (5.7%) in the external drainage group. The difference was statistically significant (P0. 023). Conclusion: the external drainage of pancreatic duct supporting tube is superior to internal drainage in preventing pancreatic fistula.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R657.5

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