胰十二指肠切除术后早期出血的预防策略和处理原则

Prevention strategy and treatment principle of early postoperative hemorrhage after pancreaticoduodenectomy

术后早期出血(EPOH)是胰十二指肠切除术(PD)术后常见并发症和重要死亡原因,其发生多与手术中血管处理不妥有关,可以理解为一种技术失败。PD需要分离和切除的组织多,创面大,血管分离、离断、切除、重建等操作多,吻合口多而复杂,因此,EPOH的原因复杂多样。EPOH最有效的预防策略是手术中对血管进行细致和稳妥处理。本文通过对PD术中所涉及的血管进行系统梳理,对这些潜在出血部位的处理策略进行总结,并对EPOH的临床思辨和处理原则进行总结,旨在进一步提升PD术中血管处理质量和EPOH防治水平。

Early postoperative hemorrhage(EPOH)is a common complication of pancreaticoduodenectomy(PD)and a main cause of death.The cause of EPOH is related to inappropriate vascular treatment during the operation,which may be recognized as a technical failure and avoided theoretically.PD is characterized by varieties of tissues that need to be separated and resected,large wound surface,many operations such as vascular separation,dissection,resection and reconstruction,and complex anastomoses.Therefore,the causes of EPOH are complex and varied.The most effective measure to prevent EPOH is to handle the vessels carefully and properly during the operation.In this paper,we systematically summarized the blood vessels involved in PD procedure,and the treatment strategies of these potential bleeding sites,and the clinical thinking and treatment principles of EPOH,so as to improve the quality of vascular treatment in PD procedure and to prevent EPOH.