胰十二指肠切除术后出血原因分析

Postoperative bleeding after pancreaticoduodenectomy

目的探讨胰十二指肠切除术后腹腔及消化道出血的相关危险因素。方法回顾性分析我院2003-2013年共237例行胰十二指肠切除术患者的临床资料。结果26例发生术后出血，出血率10．9％。早期出血6例，晚期出血20例，共8例死亡。单因素方差分析显示术中输血量、术中失血量、骨骼化清扫、胰瘘、胆瘘、术前胆红素、腹腔感染为胰十二指肠切除术后出血的危险因素（均P〈0．05）。多因素方差分析发现术中失血量（0R=21．794）、胰瘘（DR=15．440）、术前胆红素（OR=20．793）、腹腔感染（0R=5．477）为胰十二指肠切除术后出血的危险因素（均P〈0．05）。结论术中失血量≥600ml、胰瘘、术前胆红素≥171mmol/L、腹腔感染为胰十二指肠切除术后出血的独立危险因素。

Objective To explore the risk factors for post pancreaticoduodenectomy （PD） bleeding. Methods Clinical data of 237 PD cases from 2003 to 2013 were retrospectively analyzed. Results The incidence of postoperative hemorrhage was 10.9% （26/237）. Early hemorrhage occurred in 6 cases and delayed hemorrhage in 20 cases. Among these 26 patients, there were 8 deaths accounting for 3.3% of the total. Univariate analysis showed that intraoperative blood loss, intraoperative blood transfusion, vessel skeleton procedure, preoperative blood serum bilirubin level, pancreatic fistula, biliary fistula, intra-abdominal infection as significant risk factors for hemorrhage （ all P 〈 0. 05 ）. Multivariate analysis results identified 4 variables as independent factors associated with hemorrhage ： intraoperative blood transfusion （ OR = 21. 794） , pancreatic fistula （ OR = 15. 440 ） , preoperative blood serum bilirubin level （ OR = 20. 793 ）, intra-abdominal infection （ OR = 5.477 ）, all P 〈 0. 05. Conclusions Intra-operative blood loss ≥600 ml, pancreatic fistula, preoperative blood serum bilirubin level ≥ 171 mmol/L, and intra- abdominal infection are independent risk factors for after PD bleeding.