外科理论与实践

外科理论与实践 ›› 2019, Vol. 24 ›› Issue (01): 51-54.doi: 10.16139/j.1007-9610.2019.01.011

• 论著 • 上一篇    下一篇

腹腔双套管匀速冲洗引流治疗胰十二指肠切除术后胰漏

李伟1, 许志伟2   

  1. 1.中国人民解放军第101医院（无锡市太湖医院）肝胆外科,江苏,无锡 214044;
    2.上海交通大学医学院附属瑞金医院外科,上海 200025
  • 收稿日期:2018-02-01 出版日期:2019-01-25 发布日期:2019-02-25
  • 通讯作者: 许志伟,E-mail: Xuzhiwe@hotmail.com

Abdominal dual tube drainage with continuous irrigation in treatment of pancreatic fistula after pancreatoduodenectomy

LI Wei1, XU Zhiwei2   

  1. 1. Department of Hepatobiliary Surgery, The PLA 101 Hospital (Wuxi Taihu Hospital), Jiangsu Wuxi 214044, China;
    2. Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Received:2018-02-01 Online:2019-01-25 Published:2019-02-25

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摘要： 目的: 探讨腹腔双套管匀速冲洗引流在胰十二指肠切除术后胰漏治疗中的作用。方法: 2017年1月至2017年12月期间,在中国人民解放军第101医院肝胆外科及上海交通大学医学院附属瑞金医院外科,行胰十二指肠切除术后出现胰漏的病人,共78例,研究组和对照组各39例。研究组行腹腔双套管匀速冲洗引流治疗,对照组行间断冲洗引流治疗,其他治疗相同。对比两组病人腹腔冲洗时间、术后住院时间和冲洗过程中并发症发生率。结果: 腹腔冲洗过程中,对照组2例多脏器功能衰竭,转ICU治疗后好转;4例腹腔脓肿,经穿刺引流治疗后好转;1例迟发性腹腔出血,行数字减影血管造影（digital subtraction angiography,DSA）证实为脾动脉出血,行栓塞止血治疗后好转。两组各有1例因负压吸引过大,导致腹腔大出血,行急诊剖腹探查并止血后好转。研究组并发症发生率较对照组低,有统计学差异（P<0.05）。与对照组相比,研究组拔管时间早（26.0 d比29.2 d）,术后住院时间短（29.0 d比31.8 d）,有显著统计学差异（P<0.01）。结论: 胰十二指肠切除病人治疗术后胰漏,行腹腔双套管匀速冲洗引流,因维持小负压吸引,并发症发生率较低,恢复较快。

关键词: 滴定式, 腹腔冲洗引流, 胰十二指肠切除术, 胰漏

Abstract: Objective To investigate the effect of abdominal dual tube drainage with continous irrigation in the treatment of pancreatic fistula after pancreatoduodenectomy. Methods The cases with postoperative pancreatic fistula after pancreaticoduodenectomy from both Department of Hepatobiliary Surgery, The PLA 101 Hospital and Department of Pancrea-tic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine from January to December 2017 were inclu-ded in this study. A total of 78 cases were divided into 2 groups, study (n=39) and control (n=39). The patients were trea-ted by abdominal dual tube drainage with continuous irrigation in study group and drainage with intermittent irrigation in control group. The other treatments were similar in two groups. Abdominal drainage with irrigation duration, the postoperative duration of hospital stay and rate of complication during drainage were compared between two groups. Results During abdominal drainage with irrigation, there were 8 cases found complication in control group including 2 cases of multiple organ failure improved after ICU treatment. Four cases with abdominal abscess were cured with puncture and drainage. Delayed abdominal hemorrhage was found in one case identified to be splenic artery rupture by digital subtraction angio-graphy and treated by embolization. Abdominal massive bleeding was seen one case in 2 groups respectively because of higher negative pressure of drainage and treated by urgent laparotomy. The rate of complication in study group was lower than in control group (P<0.05). The patients in study group had shorter duration of abdominal drainage with irrigation (26.0 days vs. 29.2 days) and shorter postoperative duration of hospital stay (29.0 days vs. 31.8 days) with significant statistical difference when compared with the patients in control group (P<0.01). Conclusions In the treatment of pancreatic fistula after pancreaticoduodenectomy, abdominal dual tube drainage with continuous irrigation may have lower complication rate due to lower negative pressure of drainage and reduce postoperative hospital stay.

Key words: Titration, Abdominal drainage with irrigation, Pancreaticoduodenectomy, Pancreatic fistula

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