胃癌根治术后急性胰腺炎的发病特点和防治VIP免费

©1994-2010ChinaAcademicJournalElectronicPublishingHouse.Allrightsreserved.http://www.cnki.net第39卷第3期2003年9月青岛大学医学院学报ACTAACADEMIAEMEDICINAEQINGDAOUNIVERSITATISVol.39,No.3September2003[收稿日期]2003203216;[修订日期]2003206220[作者简介]李福年(19572),男,硕士,副主任医师。胃癌根治术后急性胰腺炎的发病特点和防治李福年1,陈栋1,王洪友1,王野2,管金平2,秦宪斌2(1青岛大学医学院附属医院普外科,山东青岛266003;2青岛海慈医院普外科)[摘要]①目的探讨胃癌根治术后急性胰腺炎的发病特点和防治方法。②方法对1016例胃癌根治术后发生急性胰腺炎4例病人的临床资料进行分析。③结果术后急性胰腺炎的发生率为0.39%。发病时间为术后11h～4d。表现为术后切口和腹部疼痛渐剧,腹痛位置模糊,肠蠕动恢复障碍,以及烦躁、出冷汗、心动过速、低血压。实验室检查:WBC(1.2～1.6)×109/L,中性粒细胞0.81～0.91。非手术治疗3例,2例治愈,1例死亡;手术治疗1例,痊愈。④结论术后切口和腹痛较剧、出冷汗、心动过速、肠功能恢复障碍是胃癌根治术后急性胰腺炎的临床特点。术中尽可能减少对胰腺的袭扰和损伤,置腹腔引流,高危病人术后慎用哌替啶镇痛,适当应用H2受体拮抗剂、生长抑素等有预防作用。[关键词]胃肿瘤;胰腺炎,急性坏死性;并发症[中图分类号]R656.6+106[文献标识码]A[文章编号]167224488(2003)0320259203ACUTEPANCREATITISFOLLOWINGRADICALGASTRECTOMYFORCARCINOMAOFTHESTOMACH:ITSFEATURES,PREVENTIONANDTREATMENTLIFu2nian,CHENDong,WANGHong2you,etal\(DepartmentofGeneralSurgery,TheAffiliatedHospitalofQingdaoUniversityMedicalCollege,Qingdao266003,China)[ABSTRACT]ObjectiveToinvestigatetheclinicalfeaturesandmanagementofpostoperativeacutepancreatitisfollowingradicalsurgeryforgastriccancer.MethodsAreviewof1016radicalgastrectomiesforcarcinomaofthestomachwasmade,inwhich,fourpatientswerefoundtohaveacutepancreatitis.Theclinicaldataofthesefourcaseswereanalyzed.ResultsThemobidityofacutepanceratitiswas0.39%(4/1016).Theyoccurredatfrom11hourstofourdayspostoperatively.Themanifestationswere:paininincisionandincreasingabdominalpainwithob2scuresites,failureofbowelmovement,anddysphoria,tachycardiaaswellashypotension.Whitebloodcellcountabove(1.2-1.6)×109/L,neutrophilbeing0.81-0.91.Threeweretreatedinconservativeway,onediedandtwocured;oneunderwentsurgeryandrecovereduneventfully.ConclusionSeverepostoperativeincisionandabdominalpain,coldsweat,tachycardiaanddisorderofbowelfunctionarefeaturesofacutepan2creatitisfollowingradicalsurgeryforgastriccarcinoma.Avoidanceofrudemanipulationandinjuryofpancreasduringoperation,abdominaldrainage,carefulpostoperativeapplicationofpethidineforhighriskpatients,properuseofH22recepterantagonistandsomatostainareconducivetopreventionofthiscomplication.[KEYWORDS]stomachneoplasms;pancreatitis,acutenecrotic;complications因胃癌根治手术剥离范围大、术后反应重等因素影响,胃癌根治术后急性胰腺炎难于及时诊断,常延误治疗,导致病人病情加重或死亡。1991～2001年间我院行胃癌根治术1016例,4例手术后早期发生急性胰腺炎,发生率为0.39%。本文就其发病原因、临床特点、诊断和预防等进行探讨。1临床资料1.1一般资料本组4例均为男性,年龄45～75岁,平均54.3岁。1例行D+2手术,2例行D+3手术,1例行D4手术;2例有饮酒嗜好,每日饮白酒约200～300g。2例肥胖病人在清扫胰腺下缘横结肠系膜内脂肪和淋巴结时,损伤胰腺下缘组织,1例在清除第6组和幽门后第17组淋巴结时切除了其周围部分胰腺组织。4例分别于手术后11、16、19h和4d发病。1.2临床表现手术后切口及腹部疼痛较剧、腹痛位置模糊,并逐渐加重,需反复应用哌替啶镇痛。另外,病人表现为烦躁、出冷汗、心动过速(106～128min-1)、肠恢复障碍;1例病人伴有肝、肾衰竭表现;1例D4手术后病人早期康复尚顺利,第3天肠蠕...