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目的总结324例胰十二指肠切除术(PD)患者围手术期的处理经验,以提高该术式的治愈率,降低并发症发生率。方法回顾性分析324例行PD患者的临床资料,全组均成功实施胰头十二指肠切除术,275例行PD,49例行保留幽门式胰十二指肠切除术(PPPD)。消化道重建均采用Child法;胰肠吻合方式303例为胰肠端端套入式吻合,21例为端侧吻合。.结果术后并发症发生率为8.0%(26/324):肝功能不全1例,胰瘘伴腹腔出血7例,1例胰管狭窄,胰腺外分泌功能不良者3例,吻合口溃疡4例,胃排空障碍6例,胆肠反流1例,淋巴瘘3例。术后30 d死亡内死亡1例。结论胰十二指肠切除术围手术期的管理对患者的预后至关重要。细心的围手术期管理,对减少术后并发症,保证患者顺利康复意义重大。
Objective To summarize the perioperative experience of 324 patients with pancreatoduodenectomy (PD) to improve the cure rate and reduce the complication rate. Methods The clinical data of 324 patients with PD were retrospectively analyzed. All patients underwent pancreatoduodenectomy, 275 underwent PD, and 49 underwent pyloric pancreaticoduodenectomy (PPPD). Child method was used for the reconstruction of digestive tract. 303 cases of pancreaticojejunal anastomosis were pancreaticojejunal anastomosis and 21 cases of anastomosis. Results The incidence of postoperative complications was 8.0% (26/324): 1 case of hepatic insufficiency, 7 cases of pancreatic fistula with celiac hemorrhage, 1 case of pancreatic duct stenosis, 3 cases of pancreatic exocrine dysfunction, 4 cases of anastomotic ulcer , Gastric emptying disorder in 6 cases, biliary and intestinal reflux in 1 case, lymphatic fistula in 3 cases. One death occurred within 30 days after operation. Conclusion Perioperative management of pancreatoduodenectomy is crucial for the prognosis of patients. Careful perioperative management, to reduce postoperative complications, to ensure the smooth recovery of patients of great significance.