摘要
目的探讨"O"形连续胆肠吻合联合经皮经肝穿刺胆道引流术(percutaneous transhepatic cholangial drainage,PTCD)在胰十二指肠切除术(pancreaticoduodenectomy,PD)中的临床应用价值。方法回顾性分析2015年6月至2017年6月期间信阳市中心医院收治的35例行PD患者的临床资料。结果所有患者均顺利完成"O"形连续胆肠吻合联合PTCD,无围手术期死亡。(1)术前置PTCD管时间为(13.24±3.39)d;入院时血总胆红素(total bilirubin,TBIL)水平为(363.67±12.26)μmol/L,PTCD后、PD术前的血总胆红素水平为(155.59±17.63)μmol/L。(2)手术时间为(231.46±18.69)min;术中出血量为(158.30±31.33)m L;肝总管断端直径为(1.3±0.2)cm;"O"形连续胆肠吻合时间为(7.31±1.52)min。(3)术后留置PTCD管时间为(8.13±1.49)d,住院时间为(27.31±5.49)d。术后发生胆汁漏1例,胰瘘5例(生化漏3例,B级胰瘘2例),腹腔感染2例,肺炎3例,切口感染2例,无术后胆肠吻合口狭窄、胆道感染及腹腔内出血发生。本组无开腹再手术患者,所有患者均顺利出院。(4)术后所有患者均获访180 d,随访期间无死亡患者,无胆汁漏、胆肠吻合口狭窄、胆道感染、胰瘘、胃肠瘘及腹腔感染发生。发生胃排空障碍1例,碱性反流性胃炎2例,予以门诊治疗后治愈。结论术前PTCD可改善患者PD术前的肝功能,提高手术的安全性。"O"形连续胆肠吻合操作简单、安全、可行,有预防胆肠吻合口狭窄的功能。对于血TBIL>170μmol/L的重度黄疸患者,"O"形连续胆肠吻合联合PTCD是PD术中可供选择的一种术式。
Objective To investigate the clinical value of ＂O＂continuous biliary-enteric anastomosis combined with percutaneous transhepatic cholangial drainage（PTCD） in pancreaticoduodenectomy（PD）.Methods The clinical data of 35 patients with PD who were admitted to Xinyang Central Hospital from June 2015 to June 2017 were retrospectively analyzed.Results All patients completed the ＂O＂ continuous biliary-enteric anastomosis combined with PTCD without perioperative death.（1） The preoperative indwelling time of PTCD tube was（13.24±3.39） d,total bilirubin（TBIL） was（363.67±12.26） μmol/L on admission and（155.59±17.63） μmol/L on preoperative after PTCD,respectively.（2） The operative time was（231.46±18.69） min,the intraoperative blood loss was（158.30±31.33） m L,the diameter of the hepatic ductal segment was（1.3±0.2） cm,and the duration of the ＂O＂ continuous biliary-enteric anastomosis was（7.31±1.52） min.（3） After surgery,the indwelling time of PTCD tube was（8.13±1.49） d,the hospitalization time was（27.31±5.49） d.Biliary leakage occurred in 1 case,pancreatic fistula occurred in 5 cases（3 cases of biochemical sputum and 2 cases of B-stage pancreatic fistula）,abdominal infection occurred in 2 cases,pneumonia occurred in 3 cases,wound infection occurred in 2 cases.No postoperative biliary-enteric anastomosis stenosis,biliary tract infection,and intra-abdominal hemorrhage occurred.There was no laparotomy patients in this group and all patients were discharged.（4） All patients were followed-up for 180 days after surgery.No death,bile leakage,biliary-enteric anastomotic stenosis,biliary tract infection,pancreatic fistula,gastro-intestinal leakage,and abdominal infection occurred.One case of delayed gastric emptying and 2 cases of alkaline reflux gastritis were cured after outpatient treatment.Conclusions The preoperative PTCD can improve the preoperative liver function and increase the security of PD.＂O＂ continuous biliary-enteric anastomosis is simple,safe,feasible,and has the function of preventing biliary-enteric anastomosis stenosis.For severe jaundice patients with blood TBIL 170 μmol/L,the ＂O＂ continuous biliary-enteric anastomosis combined with PTCD is an alternative surgical procedure for PD.
作者
陈涛
周明银
CHEN Tao, ZHOU Mingyin(Department of General Surgery, Xinyang Central Hospital, Xinyang, Henan 464000, P. R. China)
出处
《中国普外基础与临床杂志》
CAS
2018年第8期975-981,共7页
Chinese Journal of Bases and Clinics In General Surgery
关键词
“O”形连续胆肠吻合
经皮经肝穿刺胆道引流术
胰十二指肠切除术
并发症
＂O＂continuous biliary-enteric anastomosis
percutaneous transhepatic cholangial drainage
pancreaticoduodenectomy
complication
