胰十二指肠切除术后出血的防治

Prevention and treatment of hemorrhage after pancreatoduodenectomy

胰十二指肠切除术（pancreaticoduodenectomy,PD）是治疗胰头、十二指肠及壶腹部恶性肿瘤及部分良性疾病的主要手术方式,其手术范围广,创伤大,并发症和手术病死率也相对较高。PD主要术后并发症包括胰瘘、胆瘘、乳糜瘘、术后出血、腹腔感染、胃排空延迟等[1],其中术后出血是一种严重并发症,可危及患者生命[2]。

Postpancreatectomy hemorrhage（PPH）is a rare but dreaded complication after pancreaticoduodenectomy（PD）.Due to differences in time of onset,localization and clinical impairment,there is no consistent management algorithm.Postoperative pancreatic fistula,bile leakage and intraabdominal abscess are important risk factors for post-pancreaticoduodenectomy hemorrhage.Sentinel bleed is an early warning sign of PPH.When sentinel bleeding occurs,an emergency angiography should be considered as an option either for definite treatment or at least for bridging time until the operation and for stabilizing the patient for the relaparotomy.Surgery remains a therapeutic option if no interventional radiology is available,or patients cannot be resuscitated for an interventional treatment.