通过分析胰头癌患者经保留幽门胰十二指肠切除（PPPD）术后吻合口瘘合并感染病例的临床资料，总结和提高诊治经验。

2014年2月至2016年8月四川省宣汉县人民医院收治胰头癌患者经PPPD术后发生胰瘘合并感染12例，采用保守治疗，包括禁饮禁食、静脉营养支持、水电解质平衡管理，持续冲洗引流和胃肠减压，原窦道置入双腔引流管，同时加强还原性谷胱甘肽+甲氧苄啶等药物治疗。

2例保守治疗失败，中转手术治疗。所有患者均痊愈，未见脓毒症、腹腔感染、皮肤感染，出现2例胃排空障碍；瘘道愈合时间（39.4±5.4）d；治疗72 h后患者血淀粉酶（AMY）、尿胰蛋白酶激活肽（TAP）、C反应蛋白（CRP）水平均低于治疗前，差异有统计学意义（t=24.651、18.092、4.135，均P<0.01）。

胰头癌患者经PPPD术后若发生吻合口瘘合并感染，需加强引流管理、控制感染，采取持续胃肠减压，联合肠外肠内营养支持、应用还原性谷胱甘肽等药物；当出现胰瘘或严重肠瘘应尽早发现和明确诊断，采取综合治疗，必要时手术，以治愈胰肠吻合口瘘。

To summarize the diagnosis and treatment of pancreatic head carcinoma patients with anastomotic leakage and infection after pylorus-preserving pancreaticoduodenectomy (PPPD).

From February 2014 to August 2016, twelve patients had anastomotic leak complicated with infection of pancreatic head carcinoma after PPPD operation in Sichuan Xuanhan People’s Hospital. They received conservative treatment, including fasting, intravenous nutrition, water and electrolyte balance management, drainage and decompression, and original sinus placement of double lumen drainage tube. Meanwhile, drug treatment by injection of reduced glutathione+trimethoprim were given.

Conservative treatment failed in 2 patients, who were transferred to open operation. All patients were cured, with no sepsis, abdominal infection or skin infection. Gastric emptying disorder was found in 2 cases. The fistua healing time was (39.4±5.4) d; after 72 h treatment, serum amylase (AMY), urinary trypsin activation peptide (TAP) and C-reactive protein (CRP) levels were lower than those before treatment, the differences were statistically significant (t=24.651, 18.092, 4.135, all P<0.01).

For patients with pancreatic head carcinoma undergoing anastomotic leakage complicated with infection after PPPD operation, it needs to strengthen the management of drainage, infection control, continuous gastrointestinal decompression, parenteral and enteral nutrition support, and drug application. The pancreatic fistula or severe intestinal fistula should be found and given definite diagnosis as soon as possible, followed by comprehensive treatment and necessary surgery measurement.