胰十二指肠切除术后出血18例临床分析  

Postpancreaticoduodenectomy haemorrhage:a report of 18 cases

作　　者：肖卫东[1] 李勇[1] 蔡军[1] 曾林山[1] 余永欢[1] 李学明[1] 揭志刚[1] 

机构地区：[1]南昌大学第一附属医院普通外科,江西南昌330006

出　　处：《中国现代医学杂志》2011年第28期3541-3543,3547,共4页China Journal of Modern Medicine

摘　　要：目的探讨胰十二指肠切除（pancreaticoduodenectomy,PD）术后出血的原因和防治。方法回顾性分析2001年1月~2010年4月该院施行的279例PD术的临床资料。术后出血的诊断采用国际胰腺外科研究协作组（ISGPS）的胰腺切除术后出血（PPH）定义及分级标准。结果 18例（6.5%,18/279）发生术后出血,其中消化道出血6例,腹腔内出血12例;早期出血6例,迟发性出血12例;轻度5例,重度13例;B级11例,C级7例。出血时间为术后1h～20d,中位时间为5.5d。再手术10例（55.6%,10/18）,死亡4例（22.2%,4/18）。结论及时而果断的再手术是处理PD术后并发出血的一个重要手段。精细熟练的操作、严密吻合、彻底止血及有效预防胰瘘、腹腔感染等并发症的发生是减少术后出血的关键。【Objective】To explore the cause,prevention and treatment of postpancreaticoduodenectomy haemorrhage.【Methods】The clinical data of 279 patients undergoing PD between January 2001 and April 2010 were retrospective analyzed.The diagnosis of haemorrhage was according to the definition and classification of postpancreatectomy haemorrhage（PPH） proposed by international study group of pancreatic surgery（ISGPS）.【Results】PPH occurred in 18 patients（6.5%,18/279）,including 6 intraluminal and 12 extraluminal PPH.Early haemorrhage was recorded in 6 patients,and late haemorrhage in 12 patients.5 patients were mild and 13 severe PPH.According to the clinical grading of ISGPS,11 belongs to Grade B and 7 belongs to Grade C.The median time of onset was 5.5 days.Ten（55.6%,10/18） patients underwent reoperation.The overall mortality was 22.2%（4/18）.【Conclusion】Timely and decisive reoperation is an important method to management of PPH.The meticulous operative technique,complete hemostasis,prevention of pancreatic fistula and intra-abdominal infection are the keys to reduce PPH.

关 键 词：胰十二指肠切除术 手术后出血 治疗 

分 类 号：R656.6[医药卫生—外科学]