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1957～1993年因壶腹周围癌而行胰十二指肠切除术131例,全组手术早期并发症计61例,发生率46.5％;手术死亡13例,死亡率为9.9％。本文就其严重并发症胰、胆瘘及出血防治进行了讨论。胰漏的预防关键在于胰腺残端游离充分,吻合层次精确、张力小,胰管常规置引流,胆肠与胰肠吻合口相距10cm为宜。一旦发生胰瘘,充分引流非常重要,TPN可以提高其治愈率。胆肠吻合放置支撑引流管是必要的。术中仔细止血,减少输血量,是防止出血及休克的重要措施。消化道重建以Child术式为佳。
From 1957 to 1993, 131 cases of pancreaticoduodenectomy were performed for periampullary cancer. The early complications of the whole group were 61 cases, the incidence rate was 46.5%; 13 cases died after operation, and the death rate was 9.9%. This article discusses the prevention and treatment of pancreatic, biliary and hemorrhage in its severe complications. The key to the prevention of pancreatic leakage is that the pancreatic stump is free, the anastomosis level is accurate, the tension is small, the pancreatic duct is usually placed and drained, and the anastomosis of the pancreatic intestine and pancreas should be 10 cm apart. Once pancreatic fistula occurs, adequate drainage is very important and TPN can increase its cure rate. Biliary and intestinal anastomosis to support the drainage tube is necessary. Intraoperative careful hemostasis to reduce blood transfusions is an important measure to prevent bleeding and shock. The reconstruction of the digestive tract is best done with the Child technique.