胰十二指肠切除术及保留十二指肠的胰头(颈)切除术后出血原因及处理  

Hemorrhage after duodenopancreatectomy

作　　者：陆才德[1] 吴丹[2] 裘丰[1] 严志龙[1] 林汉庭[2] 沈迎春[1] 吴胜东[1] 

机构地区：[1]宁波大学医学院 [2]浙江大学医学院附属二院外科

出　　处：《中华普通外科杂志》2007年第12期899-901,共3页Chinese Journal of General Surgery

摘　　要：目的分析胰十二指肠切除术及保留十二指肠的胰头(颈)切除术后出血原因、处理方式与结果。方法回顾性分析361例胰十二指肠切除术及9例保留十二指肠的胰头(颈)切除术资料。结果 370例手术术后共发生出血35例,其中11例死亡。35例出血中腹内出血14例,消化道出血22例(1例兼有腹内和消化道出血)。12例出血发生于术后72 h 内(早期组),23例发生于72 h后。72 h 内出血原因多与手术操作有关,而72 h 后出血多继发于胰胆漏或吻合口溃疡。72 h 内出血者经内镜或再手术止血8例,7例好转,死亡1例,保守治疗4例死亡3例(P<0.05);72 h 后出血者再手术与保守治疗差别不明显(P>0.05)。多元逻辑回归分析表明多项临床特征包括扩大胰十二指肠切除并未增加术后出血危险,而合并胰胆漏是术后出血的重要影响因素。结论改善手术技术,严密止血,妥善处理胰残端,预防胰胆漏发生,并积极治疗术后早期出血是降低胰十二指肠术后出血率,降低手术死亡率的重要措施。Objective To study the sources and the relationship between the management and the outcome of hemorrhage after cephalic pancreatoduodenectomy. Methods The clinical data of 370 patients who underwent pancreatic resection at the Lihuili Hospital and the Second Affiliated Hospital of Zhejiang University were retrospectively analyzed. Results Postoperative bleeding occurred in 35 patients with 11 deaths. Among those intraabominal bleeding occurred in 14 cases and gastrointestinal hemorrhage occurred in 22, with one case suffering from both. Bleeding developing within 72 hours after operation in 12 cases （early-stage group）, which was caused by improper intraoperative homeostasis. In other 23 cases, bleeding 72 hours after operation （later stage group） was caused by the erosion following pancreatic and/or bile leakage. Relaparotomy was performed in 13 cases and endoscopic homeostasis was performed in 3. Relaparotomy or endoscopic homeostasis was superior to that of conservative therapy in the early-stage group （ P 〈 0. 05 ）, but it was not the case in late-stage group（ P 〉 0. 05 ）. Pancreatic or bile leakage was identified as the significant risk factors for the postoperative bleeding. Conclusions In order to prevent the postoperative hemorrhage and to reduce the mortality of pancreatic resection, skillful techniques, expeditious homeostasis, proper management of stump pancreas and the prevention of pancreatic and bile leakage are essential.

关 键 词：胰十二指肠切除术 手术后出血 多元分析 治疗 

分 类 号：R656[医药卫生—外科学]