CAJ | 학술논문

目的探讨“关腹前创新”即在已放置胰管外引流的前提下于关腹前留置胰肠吻合口空肠襻内引流管并术后持续负压引流对胰十二指肠切除术后胰漏的预防价值.方法将该院从2003年1月到2012年12月连续10年共200例胰十二指肠切除手术患者分为两组:A组136例,为已放置胰管外引流但未留置胰肠吻合口空肠襻内引流管者；B组64例,为已放置胰管外引流且附加了留置胰肠吻合口空肠襻内引流管并术后持续负压外引流者.对照两组术后胰肠吻合口漏的发生及其临床结局.结果 200例患者共发生严重并发症14例.其中围手术期因并发真菌性败血症或胃肠吻合口渗血肾功能衰竭共死亡2例(死亡率1％),胰肠吻合口漏12例(发生率6％),均发生于A组.10例胰漏经保守治疗康复,另2例漏后并发大出血,其中1例通过再手术并置入上述胰肠吻合口空肠襻内引流管并持续负压引流及介入栓塞肝总动脉而治愈,另1例通过两次介入并最终栓塞肝总动脉后治愈.B组未发生明显胰肠吻合口漏.结论在已放置胰管外引流的前提下,通过关腹前留置胰肠吻合口空肠襻内外引流管并术后持续负压外引流这一所谓“关腹前创新”能有效防止胰十二指肠切除术后胰肠吻合口漏的发生,达到少漏或不漏的目的.
목적 탐토“관복전창신”즉재이방치이관외인류적전제하우관복전류치이장문합구공장반내인류관병술후지속부압인류대이십이지장절제술후이루적예방개치.방법 장해원종2003년1월도2012년12월련속10년공200례이십이지장절제수술환자분위량조:A조136례,위이방치이관외인류단미류치이장문합구공장반내인류관자；B조64례,위이방치이관외인류차부가료류치이장문합구공장반내인류관병술후지속부압외인류자.대조량조술후이장문합구루적발생급기림상결국.결과 200례환자공발생엄중병발증14례.기중위수술기인병발진균성패혈증혹위장문합구삼혈신공능쇠갈공사망2례(사망솔1％),이장문합구루12례(발생솔6％),균발생우A조.10례이루경보수치료강복,령2례루후병발대출혈,기중1례통과재수술병치입상술이장문합구공장반내인류관병지속부압인류급개입전새간총동맥이치유,령1례통과량차개입병최종전새간총동맥후치유.B조미발생명현이장문합구루.결론 재이방치이관외인류적전제하,통과관복전류치이장문합구공장반내외인류관병술후지속부압외인류저일소위“관복전창신”능유효방지이십이지장절제술후이장문합구루적발생,체도소루혹불루적목적.
Objective To investigate the impact of complete external drainage of pancreatic juice together with persistent negative-pressure decompression of the jejunal loop in the prophylaxis against pancreaticojejunostomy leakage (or pancreatic fistula) after pancreaticoduodenectomy.Method 200 patients who received pancreaticoduodenectomy in 10 years from January 2003 to December 2012 were divided into 2 groups:group A (n =136) complete external drainage of pancreatic juice,group B (n=64) complete external drainage of pancreatic juice and persistent negative-pressure drainage decompression of the jejunal loop with the tip of the drain being placed between the pancreaticojejunostomy and hepaticojejunostomy.The morbidities and clinical outcomes were compared between the two groups.Results There were 2 cases of perioperative death.The overall perioperative mortality was 1％.One patient died of fungal infection on the first day after the operation.Another patient died of acute renal failure one week after the operation as a result of hemorrhage at the gastrojejunostomy.Pancreaticojejunostomy leakage developed in 12 (6％) of 200 patients,all in group A.Only one patient required a re-operation.The remaining patients healed with conservative treatment.There was no case of pancreaticojejunostomy leakage in group B.Conclusions Persistent negative-pressure decompression of the jejunal loop together with direct pancreatic duct drainage after pancreaticoduodenectomy prevent collection of digestion juice with its subsequent erosion in the pancreaticojejunostomy.The prevention of high pressure formation in the jejunal loop may play a key role in preventing pancreaticojejunostomy leakage or pancreatic fistula.The use of external drainage of pancreatic juice alone was often insufficient in preventing pancreatic fistula.