Risk Factors and Treatment for Hemorrhage after Pancreaticoduodenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

GU Jun ¹ , WU Wenguang ¹ , DING Qichen ¹ , YANG Jiahua ¹ , LI Maolan ¹ , ZHANG Lin ¹ , LU Jianhua ¹ , DONG Ping ¹ , BI Jianwei ² , LIU Yingbin. ¹

1. Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China;;
2. Department of Surgery, Changhai Hospital, Shanghai Second Military Medical University, Shanghai 200433, China;

Corresponding author：

Keywords：

Pancreaticoduodenectomy; Postoperative hemorrhage; Pancreaticogastrostomy; Treatment

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Objective 　To explore the risk factors and treatment associated with postoperative hemorrhage after pancreaticoduodenectomy.　
Methods 　The clinical data of 78 patients undergoing pancreatieoduodeneetomy from May 2009 to October 2011 were retrospectively analyzed in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine.
Results 　The incidence of postoperative hemorrhage was 10.3％（8/78）. Among these eight patients, intra-abdominal hemorrhage occurred in two cases （one case of early and delayed hemorrhage respectively）, and gastrointestinal hemorrhage occurred in 6 cases （one and five cases of early and delayed hemorrhage respectively）. Univarlate analysis showed that operative blood loss, postoperative celiac infection, pancreatic fistula, and pancreaticogastrostomy were significantly associated with postoperative hemorrhage. Multivariate analysis identified for vailables as independent factors associated with postoperative hemorrhage, namely, pancreaticogastrostomy, postoperative celiac infection, and pancreatic fistula.
Conclusions 　Skillful operation, prevention of pancreatic fistula, and control celiac infection are important for reducing postoperative hemorrhage. Proper treatments should be used according to the site, onset, and severity of hemorrhage. To prevent its occurrence is the key of treatment.

Citation： GU Jun,WU Wenguang,DING Qichen,YANG Jiahua,LI Maolan,ZHANG Lin,LU Jianhua,DONG Ping,BI Jianwei,LIU Yingbin.. Risk Factors and Treatment for Hemorrhage after Pancreaticoduodenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(6): 653-656. doi: Copy

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13.	Schäfer M， Heinrich S， Pfammatter T， et a1. Managementof delayed major visceral arterial bleeding after pancreatic surgery[J]. HPB (Oxford)， 2011， 13(2)：132-138.
14.	刘颖斌，王建伟，方河清，等. 捆绑式胰肠吻合术在胰十二指肠切除术中的应用 [J]. 中华医学杂志， 2004， 84(12)：997-.
15.	刘颖斌，许斌钱，浩然，等. 捆绑式胰肠吻合术在胰十二指肠切除术中的应用 [J]. 临床外科杂志， 2004， 12(4)：212-214.
16.	-191.
17.	.
18.	， 11(3)：220-225.

1. Wente MN， Veit JA， Bassi C， et a1. Postpancreatectomy hemorrhage （PPH)： an International Study Group of Pancreatic Surgery (ISGPS) definition [J]. Surgery， 2007， 142(1)：20-25.
2. Beger HG， Gansauge F， Sehwarz M， et a1. Pancreatic head resection：the risk for local and systemic complications in 1 315 patients——a monoinatitutional experience [J]. Am J Surg， 2007，194(4S)：S16-S19.
3. Brodsky JT， Turnbull AD. Arterial hemorrhage after pancreatoduodenectomy.The‘sentinel bleed’ [J]. Arch Surg, 1991，126(8)：1037-1040.
4. Yekebas EF， Wolfram L， Cataldegirmen G， et a1. Postpancreatectomy hemorrhage：diagnosis and treatment：an analysis in 1 669 consecutive pancreatic resections [J]. Ann Surg， 2007，246(2)：269-280.
5. 楼文晖，王单松，匡天涛，等. 胰十二指肠切除术后出血 [J].中华普通外科杂志， 2008， 23(11)：886-887.
6. Blanc T， Cortes A， Goere D， et a1. Hemorrhage after pancreaticoduedenectomy：when is surgery still indicated? [J]. Am JSurg， 2007， 194(1)：3-9.
7. Choi SH， Moon HJ， Heo JS， et a1. Delayed hemorrhage afterpancreaticoduodenectomy [J]. J Am Coll Surg， 2004， 199(2)：.
8. Tien YW， Lee PH， Yang CY， et a1. Risk factors of massivebleeding related to pancreatic leak after pancreaticoduodenectomy[J]. J Am Coll Surg， 2005， 201(4)：554-559.
9. Puppala S， Patel J， McPherson S， et a1. Hemorrhagic complicationsafter Whipple surgery： imaging and radiologic intervention[J]. AJR Am J Roentgenol， 2011， 196(1)：192-197.
10. Camerlo A， Turrini O， Marciano S， et a1. Delayed arterial hemorrhageafter pancreaticoduodenectomy is conservation of hepaticarterial flow vital? [J]. Pancreas， 2010， 39(2)：260-262.
11. Sanjay P， Fawzi A， Fulke JL， et a1. Late post pancreatectomyhaemorrhage. Risk factors and modern management [J]. JOP,.
12. Wang ZJ， Wang MQ， Liu FY， et a1. Role of interventional endovasculartherapy for delayed hemorrhage after pancreaticoduodenectomy[J]. Chin Med J (Engl)， 2010， 123(21)：3110-3117.
13. Schäfer M， Heinrich S， Pfammatter T， et a1. Managementof delayed major visceral arterial bleeding after pancreatic surgery[J]. HPB (Oxford)， 2011， 13(2)：132-138.
14. 刘颖斌，王建伟，方河清，等. 捆绑式胰肠吻合术在胰十二指肠切除术中的应用 [J]. 中华医学杂志， 2004， 84(12)：997-.
15. 刘颖斌，许斌钱，浩然，等. 捆绑式胰肠吻合术在胰十二指肠切除术中的应用 [J]. 临床外科杂志， 2004， 12(4)：212-214.
16. -191.
17. .
18. ， 11(3)：220-225.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Risk Factors and Treatment for Hemorrhage after Pancreaticoduodenectomy

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