[Studies on leakage of pancreatic juice following distal pancreatectomy from the standpoint of transition of amylase and trypsin values in exudate].
[Studies on leakage of pancreatic juice following distal pancreatectomy from the standpoint of transition of amylase and trypsin values in exudate].
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从渗出液中淀粉酶和胰蛋白酶值变化角度研究远端胰腺切除术后胰液漏出的情况
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发表时间：
1994
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通讯作者：
K. Arai
中科院分区：
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作者：
K. Arai
采用乳胶橡胶选择性引流残余胰腺残端(RPS)的方法，在预防胰腺远端切除术后胰液漏出血方面取得了良好的临床效果。本研究通过测定渗出液中淀粉酶(Am：Iu/L)和胰酶(Tr：Ng/ml)的值来明确胰液的实际渗漏情况。选择33例全胃切除加远端胰腺切除的胃癌患者，其中选择性引流21例(A组)，非选择性引流12例(B组)。结果如下所示。1)A组残端渗出液中Am、Tr值均显著高于B组(p<；0.01)。A组和B组术后第1天的平均值分别为25.6×10(4)对2.6×10(4)IU/L(Am值)和324.4×10(4)对12.2×10(4)ng/ml(Tr值)。(2)平均值迅速下降，术后第6天降至最低点。3)B组不仅Am总引流量(Sigma Am：Am值之和×各引流管渗出量之和)，而且Sigma Tr均明显少于A组(p<0.01)。B组有40%以上的胰液留在腹部，未引流。结论：至少在术后3d内对残端胰液进行有效、积极的引流是预防并发症的重要措施，选择性引流是较好的方法之一。
Selective drainage method of remnant pancreatic stump (RPS) using latex rubber was devised, and I have obtained a good clinical result for the prevention of postoperative bleeding due to the leakage of pancreatic juice after distal pancreatectomy. In this study, amylase (Am:IU/L) and trypsin (Tr:ng/ml) values in exudate were measured to clarify the actual leakage of pancreatic juice. Thirty-three patients with gastric cancer who underwent total gastrectomy with distal pancreatectomy were chosen for this study; 21 cases of selective drainage (group A) and 12 cases of non-selective drainage (group B). The results are noted below. 1) Both Am and Tr values of group A in the exudate from remnant pancreatic stump were statistically higher than those of group B (p < 0.01). Mean values of group A and group B on the first post-operative day were 25.6 x 10(4) versus 2.6 x 10(4)IU/L (Am value) and 324.4 x 10(4) versus 12.2 x 10(4)ng/ml (Tr value), respectively. 2) The mean values rapidly decreased and bottomed on the sixth postoperative day. 3) Not only total drainage amount of Am (sigma Am: sum of Am value x exudate volume from each drain) but also sigma Tr in group B were markedly less than in group A (p < 0.01). It means that more than 40% of pancreatic juice remained in the abdomen without drainage in group B. In conclusion, effective and active drainage of remnant pancreatic stump for the initial three days at least is important to prevent complications and our selective drainage is one of the excellent methods.