目的 探讨生长抑素-14肽与生长激素联合应用在预防胰十二指肠切除术后并发症发生中的作用。方法 我院1995年3月至2003年3月共收治因胆总管下段癌、十二指肠乳头癌及胰头癌行胰十二指肠切除术患者48例，对其中26例（治疗组）应用生长抑素-14肽6 mg/d（持续微量泵泵入）及生长激素8 U/d（分两次肌注）治疗，余22例为对照组，术后常规应用全肠外营养及抗生素治疗，比较两组的治疗结果。结果 术后发生并发症对照组17例（77.3%），治疗组5例（19.2%），两组比较差异有显著性意义（P＜0.05）。治疗组胰液量及胰周引流液中淀粉酶的含量明显低于对照组（P＜0.05），两组术前、术后蛋白质指标，治疗组于术后第7天基本恢复到术前水平，而对照组第10天才达到术前水平。结论 联合应用生长抑素及生长激素能有效降低胰十二指肠切除术后并发症的发生率。
ObjectiveTo summarize the application status and prospect of laparoscopic pancreaticoduodenectomy (LPD).MethodThe relevant literatures about studies of LPD at home and abroad were reviewed.ResultsLPD was a difficult operation, mainly suitable for pancreatic head and periampullary benign and malignant tumors. With the development of laparoscopic techniques in recent years, LPD combined the superior mesenteric vein and portal vein resection and reconstruction, or combined multi-visceral resection was feasible, but the survival benefit of LPD with arterial resection and reconstruction and extended lymph node dissection remained to be discussed. At present, there was no clear requirement on the way to reconstruct the pancreatic fluid outflow tract, but the pancreaticojejunostomy for digestive tract reconstruction was chose by the most surgeons. The most studies had confirmed that LPD was minimally invasive and had a short-term prognosis that was not inferior to that of open pancreaticoduodenectomy. However, the results of large sample analysis about long-term survival rate and oncology results were lacking, so it was difficult to judge the advantages and disadvantages of long-term prognosis of the two methods.ConclusionsLPD is a safe, feasible, reasonable, and effective surgical method. With improvement of laparoscopic technology, LPD is expected to become a standard operation method for treatment of pancreatic head cancer and periampullary carcinoma, and oncology benefits of LPD will be further confirmed in future by large-sample clinical randomized control trials and studies of long-term prognosis follow-up.
目的 探讨保留幽门的胰十二指肠切除术的手术疗效和手术并发症的发生率。方法 回顾性总结解放军第401医院肝胆外科自2004年4月至2010年6月期间所行的37例保留幽门的胰十二指肠切除术的手术体会，术后并发症发生情况，以及术后生存率。结果 本组患者总并发症发生率为18.9% （7/37），其中胃排空障碍1例， 胰瘘3例，肺部感染2例，切口感染1例。无胆瘘、十二指肠空肠吻合口漏、消化道应激性出血等并发症发生。37例患者全部获随访，随访时间为6～54个月，平均31.4个月。1年生存率为75.7% （28/37），2年生存率为56.3% （18/32），3年生存率为34.6% （9/26）。结论 保留幽门的胰十二指肠切除术不影响胰头癌、壶腹周围癌根治的彻底性，手术并发症低，术后恢复快，是一种安全有效的手术方式。
目的:探讨胰十二指肠切除术后胰瘘的原因及其预防。方法: 2003年1月至今,对46例行胰十二指肠切除术中采取胰管空肠吻合方式的病例资料进行回顾分析。结果: 46例患者行胰十二指肠切除术后无一例发生胰瘘。结论: 胰十二指肠切除术采取胰管空肠吻合方式可有效预防胰瘘的发生。
Objective To investigate the historical evolution and the research progress of pancreaticoenterostomy method in the pancreaticoduodenectomy. Methods The related literatures of PubMed， EMBASE， Wanfang， CNKI， and VIP databases were retrieved and reviewed. The advantages and disadvantages of various pancreaticojejunostomy type in pancreaticoduodenectomy were summarized. Results The type of pancreaticoenterostomy is the major influence factors for the pancreaticoduodenectomy success or failure and the patients’s recovery. Conclusion According to the specific cases， the type of pancreaticojejunostomy in skilled operation is the key to success.
目的探讨减少胰十二指肠手术切除的死亡率和并发症的方法。方法总结分析了我院20年来因胰十二指肠切除手术死亡的10例患者，分析其死亡原因。结果发现应激性溃疡出血和胰瘘是手术死亡的主要因素。结论术后如何防止应激性溃疡出血，如何进行良好的胰肠吻合，是减少手术死亡的关键。
Objective The objective of this study is to evaluate the effect of enhanced recovery after surgery (ERAS) in the perioperative period of pancreatoduodenectomy. Methods This article conducted the forward-looking analysis on the information of 227 patients undergoing the pancreatoduodenectomy in West China Hospital from January 2016 to June 2017, and then compared the differences between the patients subjected to ERAS (ERAS group) and thosesubjected to regular measures (control group) with respect to time of setting in sickbed, time of mobilizing out ofsickbed, time of starting drink water, time of resumption of diet, exhaust time, defecation time, the time of nasogastric tube, postoperative hospitalization duration and expenses, postoperative complications, and postoperative pain scores. Results ① Postoperative indexes: by comparison of the ERAS group and the control group, it was found that the ERAS group had shorter (or lower) time of setting in sickbed, time of mobilizing out of sickbed, time of starting drink water, time of resumption of diet, exhaust time, defecation time, the time of nasogastric tube, postoperative hospitalization duration and expenses (P<0.05). ② Postoperative complications: of all postoperative complications, including pancreatic fistula, postoperative hemorrhage, delayed gastric emptying, biliary fistula, abdominal infection, incision complication, lung infection, and heart complication were without statistically significant differences (P>0.05) between the 2 groups.③ Reoperation and readmission: there was no significant difference on the incidences of reoperation and readmission between the 2 groups (P>0.05). ④ Postoperative pain scores: except 22 : 00 of the 6-day after operation, the pain scores in the ERAS group were all lower than those in the control group at 2 h and 8 h after operation, and the time points of 1–6 days after operation (8 : 00, 16 : 00, and 22 : 00), with statistically differences (P<0.05). Conclusion Without increasing the incidence of complications, ERAS may speed up the rehabilitation of patients undergoing the pancreatoduodenectomy and mitigate the pain of patients.
目的 用保留十二指肠水平段的胰十二指肠切除术及Roux-Y同步吻合重建消化道的方法，达到降低手术并发症，促进患者恢复，提高其生存质量和时间。方法 在行胰十二指肠切除术时，保留十二指肠水平段、升段、屈氏韧带及空肠上段，用RouxY同步吻合的方法将胰、胆、胃、肠重建排列，术后胆肠吻合口不置T管及空肠不置造瘘管，腹腔置2 mm硅胶管用于灌洗。结果 28例中除2例切口裂开，行二期缝合外，均顺利恢复出院。平均住院25天。无胆、胰漏，无返流性胆管、胰管炎等。随访6个月~6年，1年生存24例（85.7%），3年生存15例（53.6%），5年生存5例（17.9%）。结论 保留十二指肠水平段，消化功能恢复快，不影响根治时相关淋巴结的廓清。用Roux-Y同步吻合重建消化道，并发症少。不置T管和空肠造瘘管，对患者侵扰小，恢复快，提高了患者生存率。
ObjectiveTo evaluate the various methods in prevention of pancreatic fistula after pancreaticoduodenectomy.MethodsThe literatures over the years related to prevention of pancreatic fistula were reviewed.ResultsManagement of the pancreatic stump following pancreaticoduodenectomy played the most important role in preventing pancreatic fistula. None of the methods of pancreatic stump had proved to be perfect in preventing pancreatic fistula, though pancreaticojejunostomy was the most widely practiced reconstruct strategy in varieties of option. For pancreaticojejunostomy and pancreaticogastrostomy, the rate of this complication was 12.3% and 11.1%,respectively. In recent years, a new procedure, bindingup pancreaticoduodenectomy, had shown a promise and excellent results in prevention of pancreatic fistula, the rate of fistula was 0 for consecutive 100 cases after pancreaticoduodenectomy.ConclusionBindingup pancreaticojejunostomy have a definite effect to avoid pancreatic fistula and be worthy of being recommended