胰十二指肠切除术后早期出血29例分析

Early postpancreaticoduodenectomy hemorrhage: A multi-institutional, retrospectively analysis of 29 cases

目的 探讨胰十二指肠切除术(pancreaticoduodenectomy,PD)后早期出血(early postoperative hemorrhage,EPOH)的原因及治疗策略。方法 回顾性分析2012年1月至2022年3月在锦州医科大学朝阳市中心医院研究生培养基地等4家医疗机构接受PD治疗的312例患者的临床资料,对其术后出血情况以及EPOH的治疗方法进行总结和分析。结果 312例患者中共29例发生EPOH,发生率为9.3%。29例EPOH患者中男16例,女13例;年龄39~71岁,中位年龄61岁;消化道出血2例,腹腔出血27例;轻度出血(A级)15例,中度出血(B级)10例,重度出血(C级)4例;23例经保守治疗治愈,6例行再次手术治疗。29例EPOH患者中再发并发症11例,其中术后晚期出血1例,胰漏6例,胆漏2例,腹腔感染1例,胃排空延迟1例。所有患者术后均痊愈,未出现院内死亡病例。结论 PD后EPOH以腹腔出血为主,A、B级出血经保守治疗多能成功治愈,C级出血则通常需要再次手术治疗。发生EPOH时,针对出血原因及时处理是成功救治的关键。

Objective To investigate the causes and treatment strategies of early hemorrhage(EPOH) after pancreaticoduodenectomy(PD). Method The clinical data of 312 patients who underwent PD in 4 hospitals including Chaoyang Central Hospital from January 2012to March 2022 were retrospectively analyzed, and their general information, postoperative bleeding and EPOH treatment methods were analyzed and summarized. Result Among the 312 cases, 29 cases had EPOH, with an incidence rate of 9.3%, including 16 males and 13females;aged 39-71 years, with a median age of 61 years;2 cases of gastrointestinal bleeding and 27 cases of abdominal bleeding;Among the 29 cases, 15 cases were mild grade A, 10 cases were moderate grade B, and 4 cases were severe grade C. Six cases were treated by reoperation, and 23 cases were cured by conservative treatment. Among the 29 EPOH patients, 11 suffered from complications, including 1 late postoperative hemorrhage, 6 pancreatic fistula, 2 biliary fistula, 1 abdominal infection, and 1 delayed gastric emptying. All patients recovered after operation or conservative treatment, and no in-hospital death occurred. Conclusion EPOH after PD is mainly intraperitoneal hemorrhage. Grade A and B hemorrhage can be successfully cured by conservative treatment. For grade C hemorrhage, reoperation is usually required. Timely treatment of the causes of bleeding when EPOH occurs is the key to successful treatment.