胰十二指腸切除術后出血的病因及處理(附42例分析)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 權勝偉 , 李建國 , 金光鑫 , 林雨佳 , 龐新亞 , 李福軍 , 孫晨 , 馬東來 , 吳德全 ,  高峰

;

Corresponding?author：

高峰, Email: 2601693448@qq.com

Keywords：

胰十二指腸切除術; 手術后出血; 診斷; 治療

DOI：

10.7507/1007-9424.20160022

Video：

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Abstract Full text Figures/Tables Video References Cited by

目的總結胰十二指腸切除術(pancreaticoduodenectomy，PD)后出血的原因和防治措施。方法回顧性分析2008年1月至2014年1月期間哈爾濱醫科大學附屬第二醫院行PD治療的423例患者的臨床資料。結果 PD術后發生出血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，死亡率為8.7%；晚期出血19例，死亡7例，死亡率為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，死亡率為25.0%；消化道出血14例，死亡2例，死亡率為14.3%，腹腔出血的死亡率高于消化道出血(P=0.028)。輕度出血15例，死亡2例，死亡率為13.3%；重度出血27例，死亡7例，死亡率為25.9%，輕度出血死亡率低于重度出血病死率(P=0.037)。胰管空腸黏膜對黏膜吻合術后發生出血11例，出血率為10.6%，非黏膜對黏膜吻合術后發生出血31例，出血率為9.7%；2組比較，差異無統計學意義(P＞0.05)。手術治療24例中死亡3例(12.5%)。結論輕度腹腔出血和消化道出血經非手術治療多可治愈；晚期腹腔出血手術難度大，可嘗試介入治療；術中精細操作、選擇熟練吻合方式，預防胰瘺、膽瘺及腹腔膿腫可減少術后出血的發生。

Citation： 權勝偉, 李建國, 金光鑫, 林雨佳, 龐新亞, 李福軍, 孫晨, 馬東來, 吳德全, 高峰. 胰十二指腸切除術后出血的病因及處理(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

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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.	張大方, 李謝, 朱衛華, 等.胰十二指腸術后出血的原因及防治.中華普外科雜志, 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, 陳輝, 等.胰十二指腸術后出血的血管造影表現及介入治療.中華醫學雜志, 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, 馬優鋼, 荊良, 等.改良胰管空腸黏膜吻合術在胰十二指腸切除術中的應用.中國普通外科雜志, 2007, 16(5):468-470.
18.	向穎, 徐明清, 嚴律南, 等.胰十二指腸切除術中胰腸吻合方式與術后胰漏及吻合口出血的相關性研究.中國普外基礎與臨床雜志, 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. 張大方, 李謝, 朱衛華, 等.胰十二指腸術后出血的原因及防治.中華普外科雜志, 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, 陳輝, 等.胰十二指腸術后出血的血管造影表現及介入治療.中華醫學雜志, 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, 馬優鋼, 荊良, 等.改良胰管空腸黏膜吻合術在胰十二指腸切除術中的應用.中國普通外科雜志, 2007, 16(5):468-470.
18. 向穎, 徐明清, 嚴律南, 等.胰十二指腸切除術中胰腸吻合方式與術后胰漏及吻合口出血的相關性研究.中國普外基礎與臨床雜志, 2013, 20(5):503-507.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

胰十二指腸切除術后出血的病因及處理(附42例分析)

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