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目的肝圆韧带在胰十二指肠切除术中预防胆瘘的应用。方法我院普外科自2009年6月～2012年10月以来行胰十二指肠切除术患者52例,在术中均用肝圆韧带围绕胆肠吻合口一圈,术后出现2例胆瘘,胆瘘率由9.2%降至4.4%,取得良好的疗效。结果本组病例术后恢复均顺利,52例中2例患者发生少量胆瘘,但术后8～10d胆瘘消失,其余病例未发生胆瘘,均于术后7～9d拔出引流管。结论胆肠吻合时,将肝圆韧带围绕吻合口一圈固定,操作简单,取材方便,预防胆瘘效果好,是一种安全可行的方法。但应强调肝圆韧带围绕胆肠吻合口,不能代替精细的吻合操作及充分的术前准备,手术时仍应重视影响胆瘘的因素。
Objective To study the application of liver round ligament in the prevention of biliary fistula in pancreatoduodenectomy. Methods 52 cases of pancreaticoduodenectomy were performed in general surgery department of our hospital from June 2009 to October 2012. All patients underwent round ligament around the anastomotic site of gallbladder during operation. Fistula, biliary fistula rate decreased from 9.2% to 4.4%, and achieved good results. Results The patients recovered well after operation. A small amount of biliary fistula occurred in 2 of 52 patients, but the fistula disappeared 8 to 10 days after operation. No biliary fistula occurred in the other cases, and the drainage tube was removed 7 days to 9 days after operation. Conclusions When choledochojejunostomy, the round ligament of liver around the anastomosis fixed, simple operation, easy access, good prevention of biliary fistula, is a safe and feasible method. But should emphasize the round ligament around the bile duct anastomosis, can not replace the fine anastomosis and adequate preoperative preparation, surgery should still attach importance to the factors that affect the biliary fistula.