duodenopancreatectomy

Duodenal pancreatectomy for the surgical treatment of chronic pancreatitis. Treatment of diseases: pancreatitis, chronic pancreatitis Indication Typical duodenal pancreatectomy for chronic pancreatitis with severe pain or other complications applies to the following situations: 1. Chronic pancreatitis is mainly limited to the head of the pancreas and the uncinate process, accompanied by severe pain, and there is no obvious expansion of the pancreatic duct. 2, pancreatic head lesions, failed after pancreatic duct jejunostomy. 3, the surgeon has sufficient experience in pancreatic surgery, duodenal pancreatectomy surgery mortality rate <2%. 4, pancreatic head lumps combined with lower common bile duct obstruction or duodenal obstruction. 5, pancreatic head lumps by biopsy frozen section examination, although no cancer found, but clinically difficult to exclude the possibility of cancer, especially when the CA19 ~ 9 examination increased. 6, the patient can fully cooperate, can quit drinking and stop using narcotic drugs. Contraindications Because chronic pancreatitis is a benign lesion, surgery should be safe. 1. The operator lacks experience in duodenal pancreatectomy. 2. Diffuse lesions of the pancreas. 3, the patient does not cooperate, can not quit drinking and stop using narcotic drugs after surgery. Preoperative preparation 1. Examination of important organs such as heart, lung, liver and kidney. 2, chest X-ray film to exclude metastatic lesions. 3. Inject vitamin K to increase prothrombin activity. 4. Correct the electrolyte imbalances such as low potassium and low sodium. 5. For those who have obvious malnutrition due to too little food intake, intravenous nutrition is added 1 week before surgery to transfer whole blood and plasma to correct anemia and hypoproteinemia. 6. For patients with obstructive jaundice, oral bile salt preparations are given 1 week before surgery to reduce bacterial growth in the intestine. 7. Serve ranitidine 150mg before surgery to reduce stomach acid. 8. Apply prophylactic antibiotics. 9, serum bilirubin > 171mol / L patients, the physical condition is still suitable for surgery, do not emphasize the routine use of preoperative transhepatic biliary drainage (PTBD) to reduce jaundice, if PTBD has been done, should pay special attention to due to a large number of Electrolyte disorders caused by loss of bile, usually performed 2 to 3 weeks after drainage, to prevent biliary infection caused by PTBD. Percutaneous transhepatic gallbladder drainage can also achieve the same goal. In the case of the condition, it is feasible to introduce the drainage through the endoscope before the operation, and insert a thicker special built-in drainage tube through the common bile duct opening to the upper of the obstruction, so that the patient's condition can be improved quickly. 10. Place the gastrointestinal decompression tube before surgery. Surgical procedure 1, with the typical duodenal pancreatectomy. 2, pancreatic jejunal anastomosis can be inserted into the pancreatic jejunostomy or pancreatic duct jejunal mucosa for mucosal anastomosis, pancreatic duct built-in support tube drainage, lead out through the jejunal wall; common bile duct is generally thin, should be placed T-tube drainage, one arm Placed in the jejunum through the anastomosis. Cholecystectomy is not necessary. 3, in order to reduce pancreatic fistula after pancreatic jejunal anastomosis, in recent years, some authors use pancreatic duct occlusion method: after pancreatic duct intubation, into the pancreatic duct into the occlusion agent (such as alcohol-soluble amino acid prolamine, liquid silicone rubber, neoprene, - Cyanopropionate monomer, etc.) The pancreatic duct is blocked, and then the pancreatic jejunum is inserted into the anastomosis. This method can reduce pancreatic fistula, but it is not good for preserving pancreatic endocrine function. complication Complications after duodenal pancreatectomy are still common and can occur early in the postoperative period or after discharge. 1. Intra-abdominal hemorrhage occurred within 24 to 48 hours after surgery, mainly due to insufficient hemostasis. For example, in the rupture of the mesenteric mesenteric membrane, the treatment of the pancreatic stump, intraoperative injury of the blood vessels, the gastro-intestinal artery, and the pancreaticoduodenal artery are not properly handled. In severe cases with complicated operation and long time, there is intravascular disseminated coagulation (DIC) and blood clotting material to consume bleeding on the wound surface. Coagulopathy and bleeding due to vitamin K deficiency are rare in pre-operative preparation. If the amount of early bleeding after surgery is too high to stop quickly, emergency measures should be taken to detect the hemostasis. It should be avoided because the treatment is not timely or the use of blood pressure-up drugs can cause the patient to be in shock or hypotension for a long time, otherwise, although Bleeding can stop, but patients may die from multiple organ failure. 2, gastrointestinal bleeding after surgery is more common, can be derived from: (1) Gastrointestinal anastomotic bleeding. (2) Stress ulcers, hemorrhagic gastritis. (3) anastomotic ulcer bleeding is rare. (4) Bleeding from the blood vessels of the pancreas or other places penetrates into the intestine. In the case of postoperative upper gastrointestinal bleeding, a fiberoptic gastroscopy should be performed to find the source of the bleeding. If the amount of bleeding is too large to stop in time, hemostasis should be performed again. When choledochal or pancreatic fistula is combined after surgery, bleeding may occur due to corrosion of adjacent blood vessels. For those who have difficulty in locating the source of the bleeding, an emergency angiography can be performed to understand the source of the bleeding and to immediately stop embolization. 3, pancreatic fistula. 4, timid. 5, gastrointestinal anastomotic leakage. 6, intra-abdominal infection, underarm abscess often associated with anastomotic leakage. 7, acute renal failure. 8, liver failure. 9, gastric retention, gastric emptying dysfunction. 10, other complications such as cardiovascular complications, portal vein thrombosis and other forms. 11. Late complications after duodenal pancreatectomy may include: (1) biliary anastomotic stricture and obstructive jaundice. (2) anastomotic ulcer. (3) Diabetes. (4) pancreatic exocrine dysfunction. 12, the pancreatic duct blockage, early postoperative can be complicated by acute pancreatitis. 13, the pancreatic duct blockage, the incidence of diabetes in the later stages increased.