胰十二指肠切除术后上消化道出血  

Upper Gastrointestinal Bleeding Following Pancreaticoduodenectomy

作　　者：陈创奇[1] 詹文华[1] 梁力建[1] 陈规划[1] 汪建平[1] 唐光佐[1] 

机构地区：[1]中山医科大学附属第一医院普外科,广州510080

出　　处：《中国胃肠外科杂志》1998年第3期160-163,共4页

摘　　要：目的探讨胰十二指肠切除术后上消化道出血。方法回顾性研究我院自1983年1月至1997年12月间施行胰十二指肠切除术(PD)共115例的并发症。结果 PD 术后并发症41例(35.7%),死亡7例(6.1%);并发症中以上消化道出血(UGIB)为最多,共21例(18.3%)。按并发 UGIB 与否分为 UGIB 和非 UGIB 两组,UGIB组的 PD 术中估计失血量、输血量多于非 UGIB 组;UGIB 组的死亡率为23.8%,高于非 UGIB 组的死亡率2.1%(P<0.05)。UGIB 组死亡5例,均合并其他严重的并发症。出血的主要原因为应激性溃疡8例(38.1%),胃空肠吻合口出血6例(28.6%),胆道出血3例(14.3%),原因不明10例(47.6%);其中吻合口出血均伴不同程度的应激性溃疡。出血后的处理以保守治疗为主,手术止血6例(28.6%),保守治疗15例(71.4%),止血术后死亡3例,非手术治疗死亡2例。结论上消化道出血是 PD 术后常见的严重并发症,应积极防治。objective To investigate the complications,especially upper gastrointestinal bleeding(UGIB) after pancreaticoduodenectomy(PD).Methods The outcomes of 115 patients undergoing PD from January 1983 to December 1997 were collected and analyzed retrospectively in the hospital.Results The postopera- tive complication rate was 35.7% (41/115),of which the most common complication was UGIB(21/115, 18.3 %).The overall mortality was 6.1% (7/115).After PD the patients were divided into two groups on the base of whether UGIB was occurred or not.The mortality decreased significantly from 23.8% in the group of UGIB to 2.1% in the group of non-UGIB (P<0.05).Intraoperative estimated blood loss and blood transfusion in the group of UGIB were more than those of non-UGIB (P<0.05).Five patients with UGIB died,each with other severe complications.The main causes of bloeeding was acute stress ulcer(8/21, 38.1%),suture-line bleeding of the gastroenterostomy(6/21,28.6%),biliary bleeding (3/21,14.3%), and 10 patients (47.6%) with unclear cause.Patients with suture-line bleeding were accompanied by stress ulcer to some extent.Most UGIB can be managed conservatively.Six of these patients required reopera- tion for stopping blecding(28.6%) and fifteen were treated by nonoperative therapy (71.4%).Three pa- tients died after reoperation and two patients died with nonoperative therapy.Conclusion UGIB was one of the frequent severe complications after PD,and should be actively prevented and treated.

关 键 词：胰十二指肠切除术 上消化道出血 PD 并发症 手术治疗 

分 类 号：R573.2[医药卫生—消化系统]