Management of Hemorrage Related to Pancreatic Fistula after Pancreaticoduodenectomy （Report of 2 Cases ）_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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徐進 , 卜獻民 , 戴顯偉

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Keywords：

胰十二指腸切除術; 胰瘺; 腹腔出血; 內引流; 腹腔內沖洗

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目的探討胰十二指腸切除術后胰瘺引起腹腔大出血行外科治療的可行性。
方法在343例行胰十二指腸切除術的患者中，2例術后發生嚴重的胰瘺伴有腹腔大出血，均再次手術行胰腸分離式橋式內引流術。
結果經術后支持治療、持續腹腔沖洗、抑制胰酶分泌，治療成功，順利出院。術后隨訪18個月，沒有胰管梗阻和脫落的跡象。患者沒有發生糖尿病。
結論胰十二指腸切除術后胰瘺導致的腹腔大出血治療非常困難，通過外科再手術行胰腸分離式橋式內引流術，取得成功，避免了復雜的全胰切除，挽救了胰腺功能，提高了患者的成功救治機會，改善了患者術后的生活質量。

Citation： 徐進,卜獻民,戴顯偉. Management of Hemorrage Related to Pancreatic Fistula after Pancreaticoduodenectomy （Report of 2 Cases ）. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(1): 66-67. doi: Copy

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3.	Yeo CJ, Cameron JL, Sohn TA, et al . Six hundred fifty consecutive pancreatico-duodenectomies in the 1990s: pathology, complications, and outcomes [Ｊ] . Ann Surg, 1997; 226(3) ∶248.
4.	van Berge Henegouwen MI, Allema JH, van Gulik TM, et al . Delayed massive haemorrhage after pancreatic and biliary surgery [Ｊ] . Br J Surg, 1995; 82(11)：1527.
5.	Tien YW, Lee PH, Yang CY, et al . Risk factors of massive bleeding related to pancreatic leak after pancreaticoduodenectomy [Ｊ] . J Am Coll Surg, 2005; 201(4)：554.
6.	de Castro SM, Kuhlmann KF, Busch OR, et al . Delayed massive hemorrhage after pancreatic and biliary surgery: embolization or surgery? [Ｊ] . Ann Surg, 2005; 241(1)：85.
7.	劉穎斌，白明東，彭淑牖，等. 胰十二指腸切除術后胰瘺的防治近況 [Ｊ] . 中國普外基礎與臨床雜志， 2002； 9（3）：215.
8.	Gueroult S, Parc Y, Duron F, et al . Completion pancreatectomy for postoperative peritonitis after pancreaticoduodenectomy: early and late outcome [Ｊ] . Arch Surg, 2004; 139(1)：16.
9.	Aranha GV, Aaron JM, Shoup M, et al . Current management of pancreatic, fistula after pancreaticoduodenectomy [Ｊ] . Surgery, 2006; 140(4)： 561.
10.	Shyr YM, Su CH, Wu CW, et al . Does drainage fluid amylase reflect pancreatic leakage after pancreaticoduodenectomy? [Ｊ] . World J Surg, 2003; 27(5)： 606.
11.	華赟鵬，賴佳明，梁力建. 胰十二指腸切除術后出血39例臨床分析 [Ｊ] . 中國普外基礎與臨床雜志， 2003； 10(6)： 550.
12.	Yekebas EF, Wolfram L, Cataldegirmen G, et al . Postpancreatectomy hemorrhage: diagnosis and treatment: an analysis in 1 669 consecutive pancreatic resections [Ｊ] . Ann Surg, 2007; 246(2)：269.
13.	Tamijmarane A, Ahmed I, Bhati CS, et al . Role of completion pancreatectomy as a damage control option for post-pancreatic surgical complications [Ｊ] . Dig Surg, 2006; 23(4)： 229.

1. 沈魁，鐘守先，張圣道主編. 胰腺外科 [M] . 第1版. 北京：人民衛生出版社， 2000：399～402.
2. Allema JH, Reinders ME, van Gulik TM, et al . Results of pancreaticoduodenectomy for ampullary carcinoma and analysis of prognostic factors for survival [Ｊ] . Surgery, 1995; 117(3) ∶247.
3. Yeo CJ, Cameron JL, Sohn TA, et al . Six hundred fifty consecutive pancreatico-duodenectomies in the 1990s: pathology, complications, and outcomes [Ｊ] . Ann Surg, 1997; 226(3) ∶248.
4. van Berge Henegouwen MI, Allema JH, van Gulik TM, et al . Delayed massive haemorrhage after pancreatic and biliary surgery [Ｊ] . Br J Surg, 1995; 82(11)：1527.
5. Tien YW, Lee PH, Yang CY, et al . Risk factors of massive bleeding related to pancreatic leak after pancreaticoduodenectomy [Ｊ] . J Am Coll Surg, 2005; 201(4)：554.
6. de Castro SM, Kuhlmann KF, Busch OR, et al . Delayed massive hemorrhage after pancreatic and biliary surgery: embolization or surgery? [Ｊ] . Ann Surg, 2005; 241(1)：85.
7. 劉穎斌，白明東，彭淑牖，等. 胰十二指腸切除術后胰瘺的防治近況 [Ｊ] . 中國普外基礎與臨床雜志， 2002； 9（3）：215.
8. Gueroult S, Parc Y, Duron F, et al . Completion pancreatectomy for postoperative peritonitis after pancreaticoduodenectomy: early and late outcome [Ｊ] . Arch Surg, 2004; 139(1)：16.
9. Aranha GV, Aaron JM, Shoup M, et al . Current management of pancreatic, fistula after pancreaticoduodenectomy [Ｊ] . Surgery, 2006; 140(4)： 561.
10. Shyr YM, Su CH, Wu CW, et al . Does drainage fluid amylase reflect pancreatic leakage after pancreaticoduodenectomy? [Ｊ] . World J Surg, 2003; 27(5)： 606.
11. 華赟鵬，賴佳明，梁力建. 胰十二指腸切除術后出血39例臨床分析 [Ｊ] . 中國普外基礎與臨床雜志， 2003； 10(6)： 550.
12. Yekebas EF, Wolfram L, Cataldegirmen G, et al . Postpancreatectomy hemorrhage: diagnosis and treatment: an analysis in 1 669 consecutive pancreatic resections [Ｊ] . Ann Surg, 2007; 246(2)：269.
13. Tamijmarane A, Ahmed I, Bhati CS, et al . Role of completion pancreatectomy as a damage control option for post-pancreatic surgical complications [Ｊ] . Dig Surg, 2006; 23(4)： 229.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Management of Hemorrage Related to Pancreatic Fistula after Pancreaticoduodenectomy （Report of 2 Cases ）

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