胰十二指肠切除术后出血12例临床分析

Postoperative bleeding after pancreaticoduodenectomy:a clinical analysis of 12 cases

目的总结胰十二指肠切除术后出血的诊疗经验。方法回顾性分析行胰十二指肠切除手术且术后合并出血的12例患者的临床资料。结果12例患者中早发性出血2例，迟发性出血10例。按出血部位分为消化道出血9例，腹腔内出血3例。死亡3例，死亡率25％。7例患者行保守治疗，成功止血5例，死亡2例；2例行手术止血，成功1例，死亡1例；3例患者行内镜下止血治疗，其中1例止血成功、1例内镜止血失败后行介入栓塞治疗止血成功、1例内镜止血成功后再发出血，行手术治疗止血成功。结论术前充分评估、术中精细操作和术后规范治疗是减少术后出血发生的关键。出血发生后，应该根据出血部位、出血量、患者生命体征是否平稳等因素，个体化地采取相应的治疗措施。

Objective To summarize the experience of diagnosis and treatment of postoperative bleeding after pancreaticoduodenectomy（PD）. Methods Retrospective analysis was carried out to ana- lyze the clinical data of 12 patients with postoperative bleeding after PD. Results Among 12 patients,2 cases developed early hemorrhage and 10 patients got delayed bleeding. According to the site of bleeding, 9 patients developed alimentary tract hemorrhage and 3 patients got abdominal bleeding. Three patients died and the mortality was high to 25%. Seven patients received conservative treatment. Five of them got successful hemostasis while 2 cases died. Two patients received laparotomy but one case died. Three pa- tients received endoscopic hemostasis but only one patient got successful hemostasis. One of them got suc-cessful hemostasis by interventional embolization after the failure of endoscopic hemostasis, while the last one developed rebleeding after endoscopic hemostasis and got successful hemostasis by laparotomy. Conclusion Full preoperative assessment, refined operative procedure, and standardized preoperative treat-ment are the keys to reduce the incidence of postoperative bleeding. When postoperative bleeding occurs, the site of bleeding, the amount of blood loss, the change of vital signs and other factors should be fully assessed. Appropriate therapeutic measures should be taken timely and individually.