腹腔镜胰十二指肠切除术后出血的相关分析与总结

Postoperative hemorrhage after laparoscopic pancreaticoduodenectomy

目的对腹腔镜胰十二指肠切除术(LPD)术后出血情况进行分析和经验总结。方法回顾性分析2011年5月至2019年12月期间在湖南省人民医院行LPD的患者的临床资料。对其一般资料、术后出血的时间、出血部位、胆瘘、胰瘘和感染等短期并发症及再次手术等进行分析及经验总结。结果共356例患者纳入研究,其中男性200例,女性156例,年龄(58.0±10.5)岁。并发症发生率为33.1%(118/356);23例患者行再次手术,占6.5%(23/356);9例患者死亡,占2.5%(9/356)。并发症中发生率较高的是术后出血[15.2%(54/356)]、胰瘘[14.6%(52/356)]、腹腔感染[13.8%(49/356)]。术后初次出血的时间集中在第1~14天,其中术后第1天出血的风险最高[3.9%(14/356)],之后出血风险呈下降趋势,但是在术后第7天又有所上升。腹腔内出血患者的出血部位分布较广,而消化道出血患者中胃肠吻合口出血发生风险最高[67.9%(19/28)]。再次手术的23例患者中,有18例是由于术后出血,占78.3%(18/23)。9例死亡的患者中,有7例和术后出血密切相关。结论LPD并发症发生率较高,其中术后出血是对患者短期内恢复影响最大的并发症之一,也是导致患者再次手术和死亡的重要原因。除了胰瘘会导致术后出血,胃肠吻合口出血的情况也不容忽视。

Objective To study and analyse the results of postoperative hemorrhage after laparoscopic pancreaticoduodenectomy(LPD).Methods The clinical data of patients who underwent LPD from May 2011 to December 2019 at Hunan Provincial People's Hospital were retrospectively analyzed.The clinical characteristics of patients,onset time of postoperative hemorrhage,location of postoperative hemorrhage,postoperative biliary fistula,pancreatic fistula,infection and other short-term complications,reoperation and mortality rates were analyzed.Results Of 356 patients who underwent LPD in this study,there were 200 males and 156 females,aged(58.0±10.5)years.The postoperative complication rate was 33.1%(118/356),the reoperation rate was 6.5%(23/356),and the mortality rate was 2.5%(9/356).The most common complications were postoperative hemorrhage[15.2%(54/356)],pancreatic fistula[14.6%(52/356)]and abdominal infection[13.8%(49/356)].The onset time of postoperative hemorrhage was usually in the 1st-14th day,and the highest rate of postoperative hemorrhage was 3.9%(14/356)on the first day after surgery.The postoperative hemorrhage rate then showed a downward trend,but increased again on the 7th day.The extraluminal hemorrhage locations were relatively widely distributed,and the incidence of gastrointestinal anastomotic hemorrhage in patients with intraluminal hemorrhage was the highest[67.9%(19/28)].Of the 9 patients who died,7 were related to postoperative bleeding.Conclusions LPD resulted in a high incidence of complications.Postoperative hemorrhage was a complication that had the greatest impact on short-term recovery of patients.It was also an important cause of reoperation and death.In addition to postoperative bleeding caused by pancreatic fistula,gastrointestinal anastomotic bleeding was also clinically important.