胰十二指肠切除术后出血影响因素分析与处理

Significant impact factors of postoperative hemorrhage after pancreaticoduodenectomy

目的探讨胰十二指肠切除术后出血的原因、诊断及防治方法。方法回顾性分析2009年1月至2012年6月154例胰十二指肠切除术的临床资料。结果154例胰十二指肠切除共发生术后出血16例，发生率10．4％。2例术后临床死亡，死亡率为12．5％。16例中腹腔出血7例，消化道出血9例，1例兼有腹腔出血和消化道出血。在7例腹腔出血中，早期和晚期出血分别有5例和2例；9例消化道出血中，早期出血3例，晚期出血6例。统计分析显示，术后感染（P=0．002，P〈0．01）和胰瘘（P=0．048，P〈0．05）为术后出血的相关因素。结论胰十二指肠切除术后出血是严重并发症，术中确切止血、术后预防胰瘘、预防感染是减少术后出血的关键。应根据出血的部位、时间和严重程度及时、果断采取相应的治疗措施。

Objective To analyze the significant impact factors of postoperative hemorrhage af ter pancreaticoduodenectomy. Method The clinical data of 154 patients who underwent pancre- atieoduodeneetomy from Jan. 2009 to Jun. 2012 were retrospectively analyzed. Results The incidence of postoperative hemorrhage was 10.4%（16/154）. The mortality caused by this complication was 12.5% （2/16）. Among these patients, intra-abdominal hemorrhage occurred in seven patients, and gastrointestinal hemorrhage occurred in nine patients. One patient suffered from both these complica- tions. There were five and two patients presenting with early or delayed intra-abdominal hemorrhage, respectively. Early and delayed gastrointestinal hemorrhage occurred in three and six patients, respec- tively. Statistical analysis showed that infection （P= 0. 002, P〈0.01） and pancreatic fistula （P=0. 048, P〈0.05） are significantly associated with postoperative hemorrhage. Conclusions Postoperative hem- orrhage after pancreaticoduodenectomy is a severe complication. Adequate hemostasis and prevention of pancreatic fistula and infection are the key points in reducing postoperative hemorrhage. Proper treatments should he used according to the site. tvne of onset and severity of hemorrhage.