胰十二指肠切除术后出血的危险因素分析及预防(附220例报道)

Risk Factors and Prevention Strategy of Hemorrhage after Pancreaticoduodenectomy( A Report of 220 Cases)

目的分析胰十二指肠切除术后出血的部位、原因,探讨相应的预防策略。方法回顾性分析四川大学华西医院胰腺外科2015年1月到2017年6月共220例实施胰十二指肠切除术患者的临床资料。结果 220例患者中发生术后出血18例(8.18%),包括早期出血3例,迟发性出血15例,治愈14例,死亡4例。单因素分析表明:术前胆红素水平、术中骨骼化清扫、术后胰瘘为术后出血的危险因素(P<0.05);Logistic回归多因素分析确定2个独立危险因素与出血有关:术前胆红素水平(OR=8.221),术后胰瘘(OR=8.015)。结论胰十二指肠切除术后出血的危险因素为术前胆红素≥171umol/L及术后胰瘘。因此,降低术前黄疸水平,早期发现并处理胰瘘能有效减少术后出血的发生。

Objective To analyze the location and reason of hemorrhage after pancreaticoduodenectomy,and discuss the prevention strategy.Methods The clinical data of 220 patients who underwent pancreaticoduodenectomy were analyzed retrospectively from January 2015 to June 2017 in the pancreatic surgery department of huaxi hospital of sichuan university. Results Of all patients,18（ 8.18%） patients had hemorrhage,among whom 3 patients had grade early hemorrhage,15 patients had delayed hemorrhage,and 14 patients were cured,4 patients were died.Univarlate analysis showed that the preoperative bilirubin,skeletization procedure,pancreatic fistula were significantly associated with postoperative hemorrhage（ P〈0.05）. Multivariate analysis using logistic regression identified for vailables as independent factors associated with postoperative hemorrhage,namely,preoperative bilirubin and pancreatic fistula. Conclusion The independent risk factors for postoperative hemorrhage after PD are preoperative bilirubin more than or equal to 171μmol/L and pancreatic fistula.Thus,reduce preoperative bilirubin level,early detection and treatment of pancreatic fistula can effectively decrease postoperative hemorrhage after PD.