探讨胃癌根治术后胰瘘发生的原因及诊治.docVIP

精品论文 参考文献 探讨胃癌根治术后胰瘘发生的原因及诊治 顾天春 　　(江苏省靖江市人民医院 214500) 　　【摘要】目的:探讨胃癌根治术后胰瘘的病因、临床表现、诊断及治疗方法。方法：对26例胃癌根治术后胰瘘患者的临床资料进行回顾性分析。结果：21例患者出现胰瘘可疑症状的时间分别为术后第2、3、4、6、8天。21例均出现心动过速(HRgt;120次/min)、持续发热(Tgt;38.5℃)和血白细胞升高(WBC计数gt;15times;109/L)。影像学检查胸片提示胸腔积液10例,9例CT检查提示腹腔积液, 2例同时伴有胰腺肿胀。21例腹腔引流液淀粉酶均gt;10000U/L。21例患者中16例经保守治疗3周后治愈,另5例经再次手术引流后1～4个月治愈。结论：术中胰腺损伤是导致胃癌根治术后胰瘘的主要原因;早期诊断,充分的引流是保证术后胰瘘治愈的关键。 　　【关键词】 胃癌 胰腺瘘 　　【中图分类号】R735.2 【文献标识码】A 【文章编号】2095-1752（2014）17-0087-02 　　 Pancreatic fistula after radical gastrectomy for gastric carcinoma: report of 5cases　GU tian-chun 　　【Abstract】Objective To analyze clinical characteristics, etiology, diagnosisand treatmentofpancreaticfistula following radical gastrectomy for gastric carcinoma.M ethodsClinicaldataof5patientswithpancreaticfistulaundergoingradicalgas-trectomywere analyzed retrospectively.ResultsSuspected symptoms of pancreaticfistula occurred inthe2nd,3rd,4th,6thand8thdaysafter the firstoperation respec-tively.All patients showed tachyarrhythmia, persistent hyperpyrexia and increasedcountof leukocyte, 2 had abdominaldistention, 2 had abdominalpain, and 2 had ade-quate abdominal drainagewith a turbid appearance aswell as increased level ofamyl-ase. Imaging examination showed thatpleural effusion appeared in 21 patients, seroper-itoneum in 10, and pancreas swelling in 9. Three of 21 patients received re-operationsand the other 2 were treated conservatively. All of these patients recovered after thor-ough drainage.　Conclusion　The onset of pancreatic fistula following radical gas-trectomy is iniatiated by surgical trauma of the pancreas. Reasonable range of lymph-adenectomy plays a key role to avoid postoperative pancreatic fistula. Sufficientdrai.age of the abdominal cavity ensures a full recovery from pancreatic complications. 　　【Key words】Stomach neoplasms Pancreatic fistula 　　胰瘘是胃癌根治术后比较少见的并发症,若肿瘤局部浸润胰腺或术者操作不慎，易发生医源性胰腺损伤，导致胰瘘。胰瘘可引起水、电解质和酸碱平衡紊乱，消化液的腐蚀可导致脏器穿孔或出血、严重感染等并发症，治疗较