胰十二指肠切除术后胰肠吻合口狭窄的诊治分析
| 作者: |
1陈博滔,
1朱朝庚,
1李国光,
1李云峰,
1张治桥,
1凌争云,
2孙维佳,
1陈梅福
1 湖南师范大学第一附属医院/湖南省人民医院 肝胆外科，湖南 长沙 410005 2 中南大学湘雅医院 普通外科，湖南 长沙 410008 |
| 通讯: |
陈梅福
Email: hnsrmyy_cmf@126.com |
| DOI: | 10.3978/.2018.03.006 |
摘要
目的：探讨胰十二指肠切除（PD）术后胰肠吻合口狭窄的临床表现、危险因素及相关诊治。
方法：回顾2008年1月—2018年1月收治PD术后出现胰肠吻合口狭窄患者的临床资料，对其诊治过程和随访情况进行分析和经验总结。
结果：共纳入6例PD术后出现胰肠吻合口狭窄患者，其中原发疾病胰腺浆液性囊腺瘤1例，十二指肠乳头癌2例，慢性胰腺炎2例，壶腹部癌1例；初次手术胰肠套入式吻合5例，胰胃吻合1例；围手术期并发症包括生化漏及B级胰瘘各1例，延迟胃排空障碍1例。6例患者临床表现为术后无明显诱因的急性胰腺炎反复发作，均通过MRCP和/或CT诊断为胰肠吻合口狭窄，诊断距PD术后的中位时间为54（15~84）个月。诊断后，5例患者行胰肠吻合口重建手术，其中2例术后分别随访6、8个月无特殊不适，其余3例随访6~39个月后再发胰腺炎且反复发作，但发作次数、症状较术前稍有好转；1例患者因拒绝手术予以内科治疗，目前仍有反复发作胰腺炎。
结论：胰肠吻合口狭窄是PD术后较少见并发症之一，狭窄部位多位于胰管开口处，可能危险因素包括原发病为慢性胰腺炎、胰瘘、腹腔感染和胰胃吻合。其临床表现以反复发作胰腺炎为主，胰肠吻合口重建是较常用且安全的治疗方式，但术后仍有较高胰腺炎复发率。
关键词：
胰十二指肠切除术；胰管空肠吻合术；缩窄，病理性
方法：回顾2008年1月—2018年1月收治PD术后出现胰肠吻合口狭窄患者的临床资料，对其诊治过程和随访情况进行分析和经验总结。
结果：共纳入6例PD术后出现胰肠吻合口狭窄患者，其中原发疾病胰腺浆液性囊腺瘤1例，十二指肠乳头癌2例，慢性胰腺炎2例，壶腹部癌1例；初次手术胰肠套入式吻合5例，胰胃吻合1例；围手术期并发症包括生化漏及B级胰瘘各1例，延迟胃排空障碍1例。6例患者临床表现为术后无明显诱因的急性胰腺炎反复发作，均通过MRCP和/或CT诊断为胰肠吻合口狭窄，诊断距PD术后的中位时间为54（15~84）个月。诊断后，5例患者行胰肠吻合口重建手术，其中2例术后分别随访6、8个月无特殊不适，其余3例随访6~39个月后再发胰腺炎且反复发作，但发作次数、症状较术前稍有好转；1例患者因拒绝手术予以内科治疗，目前仍有反复发作胰腺炎。
结论：胰肠吻合口狭窄是PD术后较少见并发症之一，狭窄部位多位于胰管开口处，可能危险因素包括原发病为慢性胰腺炎、胰瘘、腹腔感染和胰胃吻合。其临床表现以反复发作胰腺炎为主，胰肠吻合口重建是较常用且安全的治疗方式，但术后仍有较高胰腺炎复发率。
Diagnosis and treatment of pancreatico-enteric anastomotic stenosis after pancreaticoduodenectomy
CorrespondingAuthor:CHEN Meifu Email: hnsrmyy_cmf@126.com
Abstract
Objective: To investigate clinical manifestations, risk factors, diagnosis and treatment of pancreatico-enteric anastomotic stenosis after pancreaticoduodenectomy (PD).
Methods: The clinical data of patients developing pancreatico-enteric anastomotic stenosis after PD treated from January 2008 to January 2018 were reviewed. The diagnosis and treatment process and follow-up results of the patients were analyzed and summarized.
Results: Six patients developing pancreatico-enteric anastomotic stenosis after PD were enrolled, of whom, the primary disease in one case was serous cystadenoma, two cases was duodenal papillary carcinoma, two patients was chronic pancreatitis and one case was ampullary carcinoma; 5 cases underwent pancreaticojejunostomy and one case underwent pancreaticogastrostomy; perioperative complications occurred in 3 cases, including biochemical leak, grade B pancreatic fistula and delayed gastric emptying in one case each. The main manifestation of the 6 patients was repeated onset of acute pancreatitis with no obvious predisposing cause after PD, and their pancreatico-enteric anastomotic stenosis were diagnosed by MRCP and/or CT. The median time from PD to diagnosis was 54 (15–84) months. After diagnosis, 5 patients underwent reconstruction of the pancreatico-enteric anastomosis, of whom, no special discomforts were noted in 2 cases within 6- and 8-month follow-up period respectively, and acute pancreatitis recurrence occurred and with repeated onset in the remaining 3 cases during follow-up from 6 to 39 months; one patient refused further surgery and subsequently still suffered from repeated onset of acute pancreatitis.
Conclusion: Pancreatico-enteric anastomotic stenosis is one of the rare complications after PD. The stenosis frequently occurs in the pancreatic duct opening. Its potential risk factors include chronic pancreatitis, postoperative pancreatic fistula, intra-abdominal infection and pancreaticogastrostomy. Its main manifestation is repeated onset of acute pancreatitis. Reconstruction of the pancreatico-enteric anastomosis is a commonly used and safe treatment method, but the recurrence rate of pancreatitis after surgery is still high.
Keywords：
Pancreaticoduodenectomy; Pancreaticojejunostomy; Constriction
Pathologic
Methods: The clinical data of patients developing pancreatico-enteric anastomotic stenosis after PD treated from January 2008 to January 2018 were reviewed. The diagnosis and treatment process and follow-up results of the patients were analyzed and summarized.
Results: Six patients developing pancreatico-enteric anastomotic stenosis after PD were enrolled, of whom, the primary disease in one case was serous cystadenoma, two cases was duodenal papillary carcinoma, two patients was chronic pancreatitis and one case was ampullary carcinoma; 5 cases underwent pancreaticojejunostomy and one case underwent pancreaticogastrostomy; perioperative complications occurred in 3 cases, including biochemical leak, grade B pancreatic fistula and delayed gastric emptying in one case each. The main manifestation of the 6 patients was repeated onset of acute pancreatitis with no obvious predisposing cause after PD, and their pancreatico-enteric anastomotic stenosis were diagnosed by MRCP and/or CT. The median time from PD to diagnosis was 54 (15–84) months. After diagnosis, 5 patients underwent reconstruction of the pancreatico-enteric anastomosis, of whom, no special discomforts were noted in 2 cases within 6- and 8-month follow-up period respectively, and acute pancreatitis recurrence occurred and with repeated onset in the remaining 3 cases during follow-up from 6 to 39 months; one patient refused further surgery and subsequently still suffered from repeated onset of acute pancreatitis.
Conclusion: Pancreatico-enteric anastomotic stenosis is one of the rare complications after PD. The stenosis frequently occurs in the pancreatic duct opening. Its potential risk factors include chronic pancreatitis, postoperative pancreatic fistula, intra-abdominal infection and pancreaticogastrostomy. Its main manifestation is repeated onset of acute pancreatitis. Reconstruction of the pancreatico-enteric anastomosis is a commonly used and safe treatment method, but the recurrence rate of pancreatitis after surgery is still high.