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胰头十二指肠切除术(PD)是治疗胰腺恶性及某些良性疾病的主要方法。但是PD的术后并发症的发生率非常高,其中胰肠吻合口瘘(PF)是最常见、最危险的并发症之一。文献报道PF是影响胰腺术后死亡率的独立因素,而胰腺断端处理方法的选择可以影响胰瘘的发生。因此在处理胰腺断端时,术式的选择是相当重要的。正常胰腺组织柔软、脆弱且供血丰富,在与消化道直接缝合时,易使缝线处的胰腺组织撕裂是胰腺断端较难处理的原因之一。因此,正确的吻合方式可在一定程度上减少PF的发生。但是至今仍然没有一种吻合方式显示相对较好的预后,胰腺断端的吻合方式目前仍是一个值得探讨的问题。本文就目前国际常用的术式,即胰腺断端的处理方式及其手术的适应症和优缺点进行介绍,以期对降低PD术后胰瘘的发生和改善PD术后生活质量提出一定借鉴。
Pancreaticoduodenectomy (PD) is the primary treatment for pancreatic malignancies and certain benign diseases. However, the incidence of postoperative complications of PD is very high, of which pancreatic enterostomy (PF) is one of the most common and the most dangerous complication. Reported in the literature PF is an independent factor affecting postoperative pancreatic mortality, and the choice of pancreatic stump treatment can affect the occurrence of pancreatic fistula. Therefore, in the treatment of pancreatic stump, the surgical choice is very important. Normal pancreatic tissue is soft, fragile and rich in blood supply, in the direct contact with the digestive tract, easy to make the suture the pancreatic tissue at the tear is one of the reasons difficult to deal with the stump of the pancreas. Therefore, the correct way of anastomosis can reduce the occurrence of PF to a certain extent. However, to date, there is still no one way to show a relatively good prognosis. The anastomosis of the anterior segment of the pancreas is still a question worth exploring. This article describes the current commonly used surgical procedures, that is, the treatment of pancreatic stumps and its surgical indications and advantages and disadvantages are introduced in order to reduce postoperative PD pancreatic fistula and improve the quality of life after PD some reference.