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目的通过对胰十二指肠切除术后近期再手术病例的临床分析,探讨胰十二指肠切除术后近期非计划性再手术的原因、预防及处理措施。方法对北京协和医院2000年3月至2009年8月收治的56例胰十二指肠切除术后近期因不同原因非计划性再手术患者的临床资料进行回顾性分析,分析再手术原因、诊断及再手术方式。结果再手术56例中,腹腔大出血16例,上消化道大出血11例,胰漏7例,腹腔脓肿5例,肠梗阻4例,胃排空障碍2例,腹腔引流管断裂2例,阴性再手术2例,胆漏2例,切口裂开5例。再次手术后死亡7例,余痊愈。再手术死亡率12.5%。结论加强围手术期管理,术中精细操作,合理放置引流管以充分引流,加强术后观察,提高首次手术质量,是提高胰十二指肠切除术疗效的关键,而合理掌握再手术指征、实施及时有效的再次手术可以避免疾病进一步恶化。
Objective To investigate the causes, prevention and treatment measures of recent unplanned reoperation after pancreatoduodenectomy through the clinical analysis of recent reoperation after pancreatoduodenectomy. Methods The clinical data of 56 patients who underwent unplanned reoperation after pancreatoduodenectomy from March 2000 to August 2009 in Peking Union Medical College Hospital were retrospectively analyzed. The causes of reoperation, diagnosis And re-operation. Results Reoperation in 56 cases, intraperitoneal hemorrhage in 16 cases, 11 cases of upper gastrointestinal bleeding, pancreatic leakage in 7 cases, 5 cases of abdominal abscess, intestinal obstruction in 4 cases, gastric emptying in 2 cases, abdominal drainage tube rupture in 2 cases, negative and then Surgery in 2 cases, bile leakage in 2 cases, incision split in 5 cases. After surgery again died in 7 cases, I recovered. Reoperation mortality was 12.5%. Conclusion To improve perioperative management, intraoperative fine operation, reasonable placement of drainage tube to fully drain, strengthen the postoperative observation and improve the quality of the first operation is the key to improve the curative effect of pancreatoduodenectomy, and reasonably grasp the re-operation indications , The implementation of timely and effective re-surgery to prevent further deterioration of the disease.