【摘要】目的 总结胰十二指肠切除术(pancreaticoduodenectomy,PD)早期（术后30 d内）并发症发生的相关危险因素，指导围手术期患者的有效治疗。方法 回顾性分析2002年1月至2007年1月期间71例行PD的临床资料,分析早期并发症的发生情况及相关影响因素。结果 PD术后并发症发生率为46.5%(33/71)。Logistic多变量分析确定了2个与PD术后早期并发症相关的变量即术中输血量≥800 ml(OR=8.227)和胰液引流入肠道(OR=5.134)。结论 PD的手术风险目前仍较高，运用胰液外引流、加强围手术期处理是预防并发症的重要环节。
Objective To study the effects of malondialdehyde (MDA), superoxide dismutase (SOD) and tumor necrosis factor-α (TNF-α) on brain tissue in rats with pancreatic encephalopathy (PE). Methods Thirty-six Wistar rats were randomly divided into control group (n=6) and PE model group (n=30). In control group, rats were injected with normal saline by internal carotid artery (0.1 ml/100 g) and were killed on the first day after the injection. In PE model group, rats were injected with phospholipases A2 (0.1 ml/100 g, 1 000 U/0.1 ml) by internal carotid artery, to establish animal model of PE in rat and 10 rats were killed on day 1, 3, 7 respectively after the injection. The changes of water content in the brain were measured. Leucocytes aggregation and margination in the microvessels, and the changes of cerebral cells and nerve fibers were observed. The levels of MDA, TNF-α and the activity of SOD were tested in the brain homogenate in rats. Results In PE model group, water contents of brain increased; The phenomena of leucocytes accumulation and margination, cellular edema of neurons and demyelination of nerve fibers became more obvious; The levels of MDA and TNF-α increased significantly than those in the control group, while the activity of SOD reduced (P＜0．05， P＜0.01)． Conclusion Inthe rat model of PE, MDA, SOD, and TNF-α play important roles on the occurrence and development of brain injury.
Objective To explore the situation and prevention of pancreaticoduodenectomy perioperative complications. Methods The clinical data of 111 cases of pancreaticoduodenectomy were retrospectively analyzed， and the possible factor of complications was analyzed. Results There were postoperative complications in 48 patients （43.2%）， which one kind complication occurred in 25 cases， two kinds in 15 cases， and three kinds or more in 8 cases. Four cases （3.6%） died after operation. Conclusions Pancreaticoduodenectomy is a higher risk surgery in abdominal operation. Strengthen perioperative prevention and treatment are important measures to reduce morbidity and mortality after pancreaticoduodenectomy.
Objective To explore the clinical value of the improved style of pancreatodeodenectomy. Methods Retrospective analysis the data of 111 cases of pancreatodeodenectomy. Forty-one cases of 111 cases were performed the modified Whipple pancreatic jejunal anastomosis， which reconstruction residual pancreatic duct jejunum into the intestinal mucosa sets of accurate end to side anastomosis type （modified group）. Another 70 cases were performed the conventional Whipple pancreatic jejunal anastomosis， which classic lines set into the pancreas jejunum anastomosis （conventional group）. The incidence rate of pancreatic fistula after operation were compared in two groups. Results The postoperative recovery in modified group was smooth， and there was no case of pancreatic fistula. Thirteen cases （18.57%） had pancreatic fistula in conventional group. The difference of incidence rate of pancreatic fistula between two groups was statistically significant （P＜0.05）. The difference in other complications such as gastrointestinal bleeding， delayed gastric emptying， biliary fistula， abdominal infection， lung infection， and wound infection were no statistically significant （P＞0.05）， and the difference of survival rate was also no statistically significant （P＞0.05） in two groups. Conclusions Pancreatic duct jejunum end to side into the mucous membrane of the mucosal anastomosis sets of pancreatodeodenectomy can significantly prevent pancreatic fistula， it is worth to promote the use in clinical work.