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目的总结壶腹周围癌区域性胰腺切除术术后近期并发症,探讨其防治策略。方法分析比较1997年12月-2004年7月胰腺肿瘤外科专业小组建立前后325例壶腹周围癌区域性胰腺切除术术后近期并发症的发生情况,总结术中术后的处理方法。结果1997年12月-2001年 12月109例病例,2002年1月-2004年7月216例病例。前后两阶段术后近期发生总并发症例数分别为21例(19．3％)和18例(8．3％),总死亡例数分别为4例(3．7％)和0例(0．0％)。前后两阶段术后近期胆胰瘘的发生率分别为8．3％和3．2％;腹腔内大出血的发生率分别为3．7％和0．0％,差异均有统计学意义(P<0．05)。结论科学的手术可行性评估、胰腺肿瘤外科专业手术小组的建立、合理的围手术期处理是降低区域性胰腺切除术术后并发症发生率和死亡率的关键。
Objective To summarize the recent complications of regional pancreatectomy after ampullary cancer and to explore its prevention and treatment strategies. Methods The incidence of postoperative complications in 325 cases of periampullary carcinoma after regional pancreatectomy was analyzed and compared between December 1997 and July 2004 before and after the establishment of pancreatic tumor surgery team. Results A total of 109 cases from December 1997 to December 2001 and 216 cases from January 2002 to July 2004 were included. There were 21 cases (19.3%) and 18 cases (8.3%) of the total number of postoperative complications in the two stages before and after the operation, respectively. The total number of deaths were 4 (3.7%) and 0 .0%). The incidences of recent biliary and pancreatic fistulas were 8.3% and 3.2% respectively before and after the operation. The incidences of intra-abdominal hemorrhage were 3.7% and 0.0%, respectively, and the differences were statistically significant (P <0.05). Conclusions Scientific feasibility assessment, establishment of surgical team of pancreatic tumor surgery and reasonable perioperative management are the keys to reduce the incidence of postoperative complications and mortality in patients undergoing regional pancreatectomy.