摘要
目的改进胰十二指肠切除术式,以便于处理并发症及直观随访.方法对42例胰十二指肠切除术患者,采用Child法消化道重建.距胰肠端侧吻合口形成5～6 cm的空肠盲襻,将其固定在相应投影部位的腹壁皮下.结果32例术后恢复顺利,另10例术后发生的胰漏、胆漏、出血等并发症,通过该盲襻插入胆道镜进行直观处理,均治愈.术后远期用该方法随访直视观察22例,发现肿瘤复发5例,胆道狭窄4例,胆道蛔虫症1例.结论该术式不产生新的并发症;可与传统术式相结合;术后可对胰肠吻合口、胆肠吻合口漏和出血直观观察和处理,并能对各吻合口及残胰断端进行直观随访.
Objective To improve the technique of pancreatoduodenectomy in order to facilitate the management of complications and direct observation on follow up. Methods Pancreatoduodenectomy and Child＇s method of digestive tract reconstruction was performed in 42 pahents. A blind loop of jejunum 5 to 6 cm in length was constructed beyond the pancreatojejular anastomosis and it was fixed to the subcutaneous tissue of the adjacent abdominal wall. Results Thirty-two cases recovered uneventfully, and 10 cases had complications induding pancreatic and biliary leakage and hemorrhage. These complications were successfully treated under direct vision by choledochoscope passed into the blind jejunal loop. This method of observation was used for long-time follow up in 22 cases, and revealed ercurrent tumor（ n = 5 ） , bile duct stricture （ n = 4 ） and bile duct ascariasis （ n = 1 ）. Conclusions This operative method did not cause new complications and it can be combined with the traditional operation. Postoperatively, direct observation and management of leakage of pancreatojejular anastomosis and biliointestinal anastomosis and hemorrhage can be accomplished, and the anastomoses and pancreatic stump can be directly observed at followup.
出处
《中国普通外科杂志》
CAS
CSCD
2005年第11期847-849,共3页
China Journal of General Surgery
