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中华肝脏外科手术学电子杂志 ›› 2017, Vol. 06 ›› Issue (03) : 177 -180. doi: 10.3877/cma.j.issn.2095-3232.2017.03.007

所属专题: 文献

临床研究

全胰腺切除术治疗Whipple术后胰腺断端出血
熊志勇1, 徐见亮2, 姚志成1, 胡昆鹏1, 李瑞曦2, 方和平2, 邓美海2,()   
  1. 1. 510530 广州,中山大学附属第三医院岭南医院普通外科
    2. 510630 广州,中山大学附属第三医院肝胆外科
  • 收稿日期:2017-03-16 出版日期:2017-06-10
  • 通信作者: 邓美海
  • 基金资助:
    广东省自然科学基金(S2013010016015); 广州市科技计划项目(2013J4100061)

Total pancreatectomy for pancreatic cut end hemorrhage after Whipple procedure

Zhiyong Xiong1, Jianliang Xu2, Zhicheng Yao1, Kunpeng Hu1, Ruixi Li2, Heping Fang2, Meihai Deng2,()   

  1. 1. Department of General Surgery, Lingnan Hospital, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510530, China
    2. Department of Hepatobiliary Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2017-03-16 Published:2017-06-10
  • Corresponding author: Meihai Deng
  • About author:
    Corresponding author: Deng Meihai, Email:
引用本文:

熊志勇, 徐见亮, 姚志成, 胡昆鹏, 李瑞曦, 方和平, 邓美海. 全胰腺切除术治疗Whipple术后胰腺断端出血[J]. 中华肝脏外科手术学电子杂志, 2017, 06(03): 177-180.

Zhiyong Xiong, Jianliang Xu, Zhicheng Yao, Kunpeng Hu, Ruixi Li, Heping Fang, Meihai Deng. Total pancreatectomy for pancreatic cut end hemorrhage after Whipple procedure[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2017, 06(03): 177-180.

目的

探讨全胰腺切除术在治疗Whipple术后胰腺断端出血的安全性和应用价值。

方法

回顾性分析2013年11月中山大学附属第三医院收治的1例行全胰腺切除术治疗Whipple术后胰腺断端出血的胆管癌患者临床资料。患者因"尿黄3周、身目黄染伴皮肤瘙痒2周"入院。腹部超声、MRI及超声内镜检查均提示壶腹部占位性病变。观察患者的发病情况、诊断、治疗及疗效。患者已签署知情同意书,符合医学伦理学规定。

结果

患者气管插管全身麻醉后,行Whipple术。术后胰腺断端出血,多次行再次手术及介入栓塞无效后行全胰腺切除术,病理检查诊断为胆囊癌。术后予胰酶制剂、胰岛素治疗后痊愈。术后患者生存良好,未见复发。

结论

全胰腺切除术可考虑作为Whipple术后严重并发症处理的选择之一。

Objective

To investigate the safety and application value of total pancreatectomy for pancreatic cut end hemorrhage after Whipple procedure.

Methods

Clinical data of 1 patient with cholangiocarcinoma who underwent total pancreatectomy for treating the pancreatic cut end hemorrhage after Whipple procedure in the Third Affiliated Hospital of Sun Yat-sen University in November 2013 were retrospectively analyzed. The patient was admitted to hospital due to yellow urine for 3 weeks, and yellow sclera and skin accompanied with cutaneous pruritus for 2 weeks. Space-occupying lesions in the ampulla were found by abdominal ultrasound, MRI and ultrasonic endoscope examination. The pathogenesis, diagnosis, treatment and clinical efficacy of the patient were observed. The informed consents of the patient was obtained and the local ethical committee approval was received.

Results

The patient underwent Whipple procedure under general anesthesia by tracheal intubation. Pancreatic cut end hemorrhage after surgery was observed and had no effects to repeated reoperation and interventional embolization therapy. Eventually, total pancreatectomy was performed. The patient was diagnosed with gallbladder carcinoma by pathological examination. The patient healed after postoperative administration of pancreatin and insulin. The patient survived well after surgery and no recurrence was observed.

Conclusion

Total pancreatectomy can be considered as one of the options for treating the severe postoperative complications after Whipple procedure.

图1 一例胆管癌患者术前影像学检查
图2 一例胆管癌患者Whipple术切除物的病理学检查
图3 一例胆管癌患者全胰腺切除大体标本
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