目的 探讨胰肠吻合术后腹腔引流液淀粉酶升高的发生时间及变化规律.方法 前瞻性收集2008年2月至2011年12月泰兴市人民医院收治的28例胰腺疾病病人临床资料,胰腺切除手术由同一医疗组完成,采用相同胰肠吻合方法.术后分别连续采集胰肠、胆肠吻合口旁引流液,进行淀粉酶测定.同时测定血清、T管内胆汁淀粉酶.采用国际国内认可的胰瘘定义对结果进行评估.结果 28例病人中,术后腹腔引流液淀粉酶异常升高85.7％ (24/28),其中早期升高型42.9％( 12/28),迟发性升高型7.1％ (2/28),再次升高型(M型)28.6％( 8/28),持续升高型7.1％ (2/28).术后发生胰瘘(ISGPF)12例(42.9％),均为A级胰瘘.经吻合口造影证实无胰肠吻合口瘘.结论 胰肠吻合术后腹腔引流液中淀粉酶升高比较常见,且有一定的规律性,这与术后胰实质胰液渗漏有关,仅少数病人可发展为具有临床意义的胰瘘.%Objective To investigate the occurrence time and variation of the amylase elevation in peritoneal drainage fluid after pancreaticojejunostomy. Methods Collected prospectively clinical data of 28 patients with pancreatic disease from 2008 February to 2011 December. Pancreatic resection was performed by the same medical group, using the same pancreaticoenteric anastomosis method. The amylase was continuously collected in cholecystoenteric anastomosis and pancreaticoenteric anastomosis drainage fluid respectively, as well as serum and T tube fluid. The results were assessed by domestic and international recognition of pancreatic fistula. Results In 28 cases, postoperative amylase in abdominal drainage fluid rised extremely by 85. 7% (24/28). The early rising type was 42. 9% ( 12/28) , the delayed rising type was 7. 1 % ( 2/28 ) , the re-rising type was 28. 6% ( 8/28 ) , the persistent rising type was 7. 1% (2/28). 12 cases (42. 9% ) presented A grade postoperative pancreatic fistula according to ISGPF, with pancreatic parenchyma fistula, without fistula of pancreaticoenteric anastomosis. Conclusion Amylase rising in peritoneal drainage fluid is common after pancreaticojejunostomy with certain regularity. It is related to postoperative pancreatic parenchymal leakage. Only a few patients may develop clinical significance of pancreatic fistula.
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