胰十二指肠切除术后出血的病因及处理(附42例分析)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 权胜伟 , 李建国 , 金光鑫 , 林雨佳 , 庞新亚 , 李福军 , 孙晨 , 马东来 , 吴德全 ,  高峰

;

Corresponding author：

高峰, Email: 2601693448@qq.com

Keywords：

胰十二指肠切除术; 手术后出血; 诊断; 治疗

DOI：

10.7507/1007-9424.20160022

Video：

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目的总结胰十二指肠切除术(pancreaticoduodenectomy，PD)后出血的原因和防治措施。方法回顾性分析2008年1月至2014年1月期间哈尔滨医科大学附属第二医院行PD治疗的423例患者的临床资料。结果 PD术后发生出血42例(9.9%)，其中死亡9例(21.4%)。42例中早期出血23例，死亡2例，死亡率为8.7%；晚期出血19例，死亡7例，死亡率为36.8%；早期出血的死亡率低于晚期出血(P=0.014)。腹腔出血28例，死亡7例，死亡率为25.0%；消化道出血14例，死亡2例，死亡率为14.3%，腹腔出血的死亡率高于消化道出血(P=0.028)。轻度出血15例，死亡2例，死亡率为13.3%；重度出血27例，死亡7例，死亡率为25.9%，轻度出血死亡率低于重度出血病死率(P=0.037)。胰管空肠黏膜对黏膜吻合术后发生出血11例，出血率为10.6%，非黏膜对黏膜吻合术后发生出血31例，出血率为9.7%；2组比较，差异无统计学意义(P＞0.05)。手术治疗24例中死亡3例(12.5%)。结论轻度腹腔出血和消化道出血经非手术治疗多可治愈；晚期腹腔出血手术难度大，可尝试介入治疗；术中精细操作、选择熟练吻合方式，预防胰瘘、胆瘘及腹腔脓肿可减少术后出血的发生。

Citation： 权胜伟, 李建国, 金光鑫, 林雨佳, 庞新亚, 李福军, 孙晨, 马东来, 吴德全, 高峰. 胰十二指肠切除术后出血的病因及处理(附42例分析). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(1): 86-90. doi: 10.7507/1007-9424.20160022 Copy

1.	Cameron JL Riall TS, Coleman J, et al. One thousand consecutive pancreaticoduodenectomies. Ann Surg, 2006, 244(1):10-15.
2.	Roulin D, Cerantola Y, Dem artines N, et al. Systematic review of delayed postoperative hemorrhage after pancreatic resection. J Gastrointest Surg, 2011, 155(6):1055-1062.
3.	Miura F, Asano T, Amano H, et al. Management of postoperative arterial hemorrhage after pancreato-biliary surgery according to the site of bleeding:re-laparotomy or interventional radiology. Hepatobiliary Pancreat Surg, 2009, 16 (1):56-63.
4.	Wente MN, Veit JA, Bassi C, et al. Postpancreatoduodenectomy hemorrhage(PPH)-an international study group of pancreatic surgery(ISGPS) definition. Surgery, 2007, 142(1):20-25.
5.	Koukoutsis I, Bellagamba R, Morris-Stiff G, et al. Haemorrhage following pancreaticoduodenectomy:risk factors and the importance of sentinel bleed. Dig Surg, 2006, 23(4):224-228.
6.	Rumstadt B, Schwab M, Korth P, et al. Hemorrhage after pancreatoduodenectomy. Ann Surg, 1998, 227 (2):236-241.
7.	Blanc T, Cortes A, Goere D, et al, Hemorrhage after pancreaticoduo-denectomy:when is surgery still indicated? Am J Surg, 2007, 194(1):3-9.
8.	Yamashita Y, Taketomi A, Fukuzawa K, et al. Risk factors for and management of delayed intraperitoneal hemorrhage after pancreatic and biliary surgery. Am J Surg, 2007, 193(4):454-459.
9.	Zhang J, Zhu X, Chen H, et al, Management of delayed post-pancreaticoduodenectomy arterial bleeding:interventional radio-logical treatment first. Panereatology, 2011, 11(5):455-463.
10.	Chua AE, Ridley LJ. Diagnostic accuracy of CT angiography in acute gastrointestinal bleeding. J Med Imaging Radiat Oncol, 2008, 52 (4):333-338.
11.	张大方, 李谢, 朱卫华, 等.胰十二指肠术后出血的原因及防治.中华普外科杂志, 2009, 24(9):732-735.
12.	Benzoni E, Saccomano E, Zompicchiatti A, et al, The role of pancre-atic leakage on rising of postoperative complications following pancreatic surgery. J Surg Res, 2008, 149(2):272-277.
13.	Brodsky JT, Turnbull AD. Arterial hemorrhage after pancreatoduo-denectomy. The'sentinel bleed'. Arch Sury, 1991, 126(8):1037-1040.
14.	de Castro SM, Kuhlmann KF, Busch OR, et al. Delayed massive hemorrhage after pancreatic and biliary surgery:embolization or surgery. Ann Surg, 2005, 241(1):85-91.
15.	徐海峰, 朱旭, 陈辉, 等.胰十二指肠术后出血的血管造影表现及介入治疗.中华医学杂志, 2013, 93(1):55-57.
16.	Sohn TA, Yeo CJ, Cameron JL, et al. Pancreaticoduodenectomy:role of interventional radiologists in managing patients and comp-lications. J Gastrointest Surg, 2003, 7(2):209-219.
17.	朱斌, 马优钢, 荆良, 等.改良胰管空肠黏膜吻合术在胰十二指肠切除术中的应用.中国普通外科杂志, 2007, 16(5):468-470.
18.	向颖, 徐明清, 严律南, 等.胰十二指肠切除术中胰肠吻合方式与术后胰漏及吻合口出血的相关性研究.中国普外基础与临床杂志, 2013, 20(5):503-507.

1. Cameron JL Riall TS, Coleman J, et al. One thousand consecutive pancreaticoduodenectomies. Ann Surg, 2006, 244(1):10-15.
2. Roulin D, Cerantola Y, Dem artines N, et al. Systematic review of delayed postoperative hemorrhage after pancreatic resection. J Gastrointest Surg, 2011, 155(6):1055-1062.
3. Miura F, Asano T, Amano H, et al. Management of postoperative arterial hemorrhage after pancreato-biliary surgery according to the site of bleeding:re-laparotomy or interventional radiology. Hepatobiliary Pancreat Surg, 2009, 16 (1):56-63.
4. Wente MN, Veit JA, Bassi C, et al. Postpancreatoduodenectomy hemorrhage(PPH)-an international study group of pancreatic surgery(ISGPS) definition. Surgery, 2007, 142(1):20-25.
5. Koukoutsis I, Bellagamba R, Morris-Stiff G, et al. Haemorrhage following pancreaticoduodenectomy:risk factors and the importance of sentinel bleed. Dig Surg, 2006, 23(4):224-228.
6. Rumstadt B, Schwab M, Korth P, et al. Hemorrhage after pancreatoduodenectomy. Ann Surg, 1998, 227 (2):236-241.
7. Blanc T, Cortes A, Goere D, et al, Hemorrhage after pancreaticoduo-denectomy:when is surgery still indicated? Am J Surg, 2007, 194(1):3-9.
8. Yamashita Y, Taketomi A, Fukuzawa K, et al. Risk factors for and management of delayed intraperitoneal hemorrhage after pancreatic and biliary surgery. Am J Surg, 2007, 193(4):454-459.
9. Zhang J, Zhu X, Chen H, et al, Management of delayed post-pancreaticoduodenectomy arterial bleeding:interventional radio-logical treatment first. Panereatology, 2011, 11(5):455-463.
10. Chua AE, Ridley LJ. Diagnostic accuracy of CT angiography in acute gastrointestinal bleeding. J Med Imaging Radiat Oncol, 2008, 52 (4):333-338.
11. 张大方, 李谢, 朱卫华, 等.胰十二指肠术后出血的原因及防治.中华普外科杂志, 2009, 24(9):732-735.
12. Benzoni E, Saccomano E, Zompicchiatti A, et al, The role of pancre-atic leakage on rising of postoperative complications following pancreatic surgery. J Surg Res, 2008, 149(2):272-277.
13. Brodsky JT, Turnbull AD. Arterial hemorrhage after pancreatoduo-denectomy. The'sentinel bleed'. Arch Sury, 1991, 126(8):1037-1040.
14. de Castro SM, Kuhlmann KF, Busch OR, et al. Delayed massive hemorrhage after pancreatic and biliary surgery:embolization or surgery. Ann Surg, 2005, 241(1):85-91.
15. 徐海峰, 朱旭, 陈辉, 等.胰十二指肠术后出血的血管造影表现及介入治疗.中华医学杂志, 2013, 93(1):55-57.
16. Sohn TA, Yeo CJ, Cameron JL, et al. Pancreaticoduodenectomy:role of interventional radiologists in managing patients and comp-lications. J Gastrointest Surg, 2003, 7(2):209-219.
17. 朱斌, 马优钢, 荆良, 等.改良胰管空肠黏膜吻合术在胰十二指肠切除术中的应用.中国普通外科杂志, 2007, 16(5):468-470.
18. 向颖, 徐明清, 严律南, 等.胰十二指肠切除术中胰肠吻合方式与术后胰漏及吻合口出血的相关性研究.中国普外基础与临床杂志, 2013, 20(5):503-507.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

胰十二指肠切除术后出血的病因及处理(附42例分析)

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