Complications and its processing of pancreas cancer surgical operation

Pancreas cancer in early days diagnose with detection not easily, the excision rate was low, after the Shu 5 year, the existence rate is in below 5%, poor after prepare, so was call it as the king in the cancer, the international medical science field listed as its one of"the unprogressive fort for 21 centuries"s more.The reason that Yi gland cancer drive such the value return to have something to do with its surgical operation death rate Gao and complications have another.(among them cause death be not a few sex)Therefore prepare to defend and reasonable processing the complications be extremely important.

To handle a good pancreas cancer want to be definitely as follows what time first:The ① pancreas cancer surgical operation is a kind of meticulous but complicated surgical operation, not but the demand consummate technique, and have to also have patience.Can't for persistently pursuing in a short time completion surgical operation.The ② pancreas cancer patient's age much is partial to greatly, the general circumstance is usually bad, can't bear to be subjected to slightly heavy stroke, past have to be careful choice case;Still need to work well to round a surgical operation period processing in the meantime, strengthen support therapy.The surgical operation Shu of the ③ pancreas cancer the type be a lot of and want to notice backlog and exchanges experience at ordinary times.Up the sea long sea hospital's organizing professional doctor's team to do surgical operations is a good example ［ one ］ :Similarly traditional Whipple surgical operation, the not- professional set implements this surgical operation 27, the complications incidence rate is 63%(17), ill rate 22%(6);Contrary, the professional set surgical operation is 125, the complications incidence rate is 34%(43), and the ill rate is only 0.8%.About 4 in the last yearses, should the professional set totally implements 134 bowel resections with 12 Yis, died.The ④ observes with nursing after want strengthen Shu in order to discover in time and carefully handle a problem.Hospital surgery sickroom nursing set in the Hua Mountain discover 12 bowel resection of Yi behind 3/4 of the belly cavity in the case lead to flow starch Mao in liquid, the content extremely increases Gao, hence strengthen a pipe nursing, the per hour checks the lucid circumstance of various pipe.In early days once if thered is 1, led flow not Chang, leak out of the liquid physical volume gather combine after hair infection, influence Yi jejunum fit together of heal and result in Yi Lou.It is thus clear that, the small problem can't neglect, either.

Pancreas cancer after operation the complications be numerous, but with the Yi Lou, stomach internal bleeding, the belly cavity Nong poisonous disease and the liver function crock up for lord.

The Yi Lou is regardless the Yi 12 bowel resections still a distant resection and the Shu all probably delivers to living Yi Lou behind.The incidence rate of the former's ising 14% ～s is 18%s.(A handful of report way is up to 40%), the incidence rate of the latter is lower and is about 5%. Yi Lou can with the result that infection inside the stomach and causticity issue of blood inside the stomach, the bane is one of the main reasons that the Shu dies begreatly hind.The prevention of Yi Lou wants to begin from the Shu type choice and exaltation technique first.In fact and regardless which kind of Shu type, such as operation not careful, all have occurrence Yi the possibility of the Lou.Currently, what most hospitals adopt is that various Yi jejunum set goes in to fit together Shu:The tumor hospital of the Chinese medical science science, hospital adopts 4:00 method Yi tube jejunum to glue a film to fit together, concord hospital in Peking adoption Yi tube the jejunum kiss to match behind the Yi remnants carry a set into the method, medicine department university in Zhejiang subsidiary two adoption bind type Yi bowel in the hospitalses fit together, etc..These methods are each has his own strong point.Can'ting neglect the reconstruction method of digest way at the time of valuing Yi bowel to fit together particularly is the lucid problem that the row row agreeable preface and the bowel contents thing row that Yi, Dan, stomach and jejunum fit together get empty.Such as front say, lead to flow to take care of in the Shu of place with Shu behind manage is also an important link, because the belly cavity leads to flow is diagnosis and prevent and cure various important means which fit together a people Lou and belly cavity to infect.Round the surgical operation's leading to flow is the window way which observes the variety in the belly cavity and notice to lead a quantity and property of flow the liquid at any time.Usually squeezing to lead to flow a tube can prevent°from stop.

The diagnosis of the Yi Lou mostly depend on clinical gain of data.Fit together discharge in the lead of neighborhood bigger such as the Yi bowel, the color and luster is shallow thin, do not glue sex, and starch Mao the content can immediately confirm for the Yi Lou over the 1000 Us/ml.Only a handful of cases need to make to build a shadow confirmation.Yi Lou as soon as confirms to namely should actively handle, well lead to flow.The one who lead to flow not Chang should go extension to lead to flow surgical operation in time.Still need to notice the patient's camp to keep to absorb at the time of leading to flow.Can pass center vein pipe first to carry on nourishment support outside the stomach and intestines.Everyday of adult calories need about the 124~145 kJs/kg), the nitrogen is about the 0.20~0.3 gs/kg;The comparison of thermal energy and nitrogen generally takes the 413~620 kJ ∶ 1 g as proper.Amino acids, glucose, fat milk, vitamin, little chemical element and electrolyte make the aqua permeate to press after mix feat.The growth suppresses a vegetable and can reduce a Yi liquid Bi for cent, everyday 0.1~0.3 gs, use 2~3 weeks can immediately make the Lou rises to 50% from 27.3% more from the rate and die of illness a rate to then decline to 22%. Grow the hormone has improvement egg white to synthesize and helps the organization to heal of function, suppress vegetable and nourishment suitable for use outside the stomach and intestines with growth to contribute to heal of Yi Lou.Condition stability and lead to flow liquid decrease behind can change to use bowel Si.

The Shu bleeds Yi behind, 12 bowel resections bleed behind of the incidence rate is 7.5%s for 5% ～s.Careful operation in Shu and the blood(especially the Yi remnants carry a department) is to prevent°from Shu behind bleed of basic assurance;Handle the good Yi Lou can avoid to bleed after the hair;Lead to flow lucid can prevent°from the belly cavity Nong poisonous disease expects behind of the causticity bleed;The usage which strengthens support method and the Gua medicine of the normal regulations A cyanotype Mao contributes to decrease and should arouse the occurrence that sex ulcer bleed.Because stop bleeding not whole with the result that of the Shu bleeds to often take place behind 24 hour after Shu inside.Blood after the Shu can derivation from lead to flow a tube.If the quantity is little, can keep on a tight observation.The belly cavity accumulates blood too much but can't derivation, the patient performance is unsteady for blood dynamics, should go belly cavity to wear to stab under the B super leading at this time, don't lose opportune moment ground to carry on surgical operation to fish for.The digest way turns to bleed to mainly come from 3 to fit together and stomach to glue a film, its performance for throw up blood with black then.3~4 weeks after the Shu the one who take place to greatly bleed inside stomach, consider the bowel fastens film top vein, stomach left rtery or stomach 12 bowel arteries to carry the possibility of causticity issue of blood.To go selectivity artery to build a shadow and bolt to fill a treatment while having a condition.

After the Shu after abscess Shu inside the stomach abscess inside the stomach is after ising a Shu lead to flow Chang not with the result that, incidence rate's ising about 4% ～s is 10%s.Its performance for fear cold, hot, the abdominal distension, the stomach peristalsis obstacle and white cell count to increase Gao Deng3.Such as can not compare with processing, often can after hair issue of blood and the belly cavity Nong poisonous disease of the causticity blood vessel.The B is super to scan a diagnosis and fixed position of contribute to this complications with CT.Can go abscess to wear to stab to place a tube to lead to flow Shu under the B super leading, when it's necessary should also again the surgical operation lead to flow.

The setting of the Dan Lou T tube may contribute to the prevention that the Dan leak, but for the sake of setting T tube but reserve longer Dan manager will influence cure for good of surgical operation sex.Luckily the incidence rate of Dan Lou has already lower now, the processing is also easy, as long as keep to lucidly and outside lead to flow, from more of the opportunity be very big.

Diabetes all whole Yis after cut off patient Shu will leave behind diabetes after the Shu and Yi 12 bowels cut off or the Yi distant excision leave behind an of diabetes about 8%.Not a few surgery patients all merge recessiveness glycouria disease.Old-age patient function in the Yi island be bad, the pancreas after operation and more easily appears diabetes, past Shu behind want to usually measurese blood sugar and wet sugar, understand the metabolism circumstance of the patient's sugar in time.This kind of patient wants to consider feeling to give a 1 U/2~6 g while add nourishment outside the stomach and intestines the sugar doesn't wait of vegetable in the Yi island.

Author's brief introduction:Zhang Yan2 Ling2(1927-), male, Ci river person of Zhejiang, the surgery learns a professor, Doctor graduate student tutor, the incumbent Hua Mountain hospital pancreas cancer make a diagnosis and give treatment the center total adviser.