胰十二指肠切除术后出血的危险因素及处理策略分析

Analysis of risk factors and treatment strategy for post-pancreaticoduodenectomy hemorrhage

目的结合临床资料分析胰十二指肠术后出血的原因和防治措施,同时探讨术后出血与临床胰瘘的关系。方法回顾性分析2008年1月至2018年12月安徽医科大学第一附属医院收治的44例胰十二指肠术后出血病人的临床资料,并分析胰瘘与出血关系。结果胰十二指肠切除术后出血发生率为10.05%(44M38),术后出血相关死亡率为11.36%(5/44)。44例术后出血病人中,早期出血19例(43.2%),迟发性出血25例(56.8%),首次术后出血中位时间为60(11.25〜210)小时。腹腔出血33例(75.0%),消化道出血11例(25.0%)。A级出血8例(18.2%),B级出血21例(47.7%),C级出血15例(34.1%)。22例采取保守治疗,8例接受介入治疗,5例行胃镜检查治疗,12例行开放手术治疗。合并临床胰瘘组病人在出血时间、出血据手术时间、出血严重等级、腹腔感染、引流管拔除时间、住院时间、医疗费用以及术后出血相关死亡率存在差异,且有统计学意义(P<0.05)。结论目前胰十二指肠术后出血发生率仍高达10.05%,术后出血相关死亡率为11.36%,临床上高度重视,综合考虑后选择合适的干预时机和策略。而合并临床胰瘘的病人,治疗周期延迟,临床情况复杂,死亡风险进一步增高。

Objective To analyze the causes and preventive measures of bleeding after pancreaticoduodenectomy combined with clinical data,and to explore the relationship between postoperative bleeding and clinical pancreatic fistula.Methods The clinical data of 44 patients with hemorrhage after pancreaticoduodenal hemorrhage admitted in the First Affiliated Hospital of Medical University of Anhui from January 2008 to December 2018 were retrospectively analyzed,and the relationship between pancreatic fistula and bleeding was analyzed.Results The incidence of bleeding after pancreatoduodenectomy was 10.05%(44/438),and postoperative bleeding related mortality was 11.36%(5/44).Among the 44 patients with postoperative bleeding,19 cases(43.2%)had early bleeding,25 cases(56.8%)had delayed bleeding,and the median time of bleeding was 60(11.25〜210)hours after the first opera-tion.Abdominal bleeding occurred in 33 cases(75%)and gastrointestinal bleeding in 11 cases(25%).Grade a hemorrhage was found in 8 cases(18.2%),grade B bleeding in 21 cases(47.7%),grade C bleeding in 15 cases(34.1%).Conservative treatment was performed in 22 cases,interventional therapy in 8 cases,gastroscopy in 5 cases,and open operation in 12 cases.There were differences in bleeding time,bleeding time,severity of bleeding,abdominal infection,drainage tube removal time,hospitalization time,medical expenses and postoperative bleeding related mortality in patients with clinical pancreatic fistula group(P<0.05).Conclusion The incidence of bleeding after pancreatoduodenal surgery is still 10.05%,and the postoperative mortality rate is 11.36%.However,patients with clinical pancreatic fistula have delayed treatment cycles,complicated clinical conditions,and increased risk of death.