胰腺切除术后迟发性大出血单中心临床分析  

Delayed massive haemorrhage after pancreatic resection

作　　者：沈岩[1] 潘德标[1] 夏伟良[1] 王伟林[1] 张珉[1] 吴健[1] 郑树森[1] 

机构地区：[1]浙江大学医学院附属第一医院肝胆胰外科,杭州310003

出　　处：《中华普通外科杂志》2014年第5期337-339,共3页Chinese Journal of General Surgery

基　　金：浙江省自然科学基金（LY12H16011）

摘　　要：目的探讨胰腺切除术后迟发性大出血的原因、治疗方法和预后。方法回顾性分析浙江大学医学院附属第一医院2003年8月至2013年8月共1554例胰腺切除术患者的临床资料。结果16例患者手术后发生迟发性大出血，其中胰十二指肠切除术13例，胰体尾切除术3例；消化道出血6例，腹腔内出血10例；再手术11例，介入止血2例，内镜止血3例；3例死亡，3例家属放弃治疗后死亡，10例治愈。结论胰腺切除术后迟发性大出血病死率高，术后胰漏和应激性溃疡是最可能的危险因素，腹腔内动脉性出血是主要致死原因。及时再手术和术后腹腔持续灌注是有效的处理方法。Objective To explore the cause, treatment and prognosis of delayed massive haemorrhage （DMH） after pancreatic resection. Method Clinical data of 1554 patients undergoing pancreatectomy in our hospital from Aug 2003 to Aug 2013 were retrospectively analyzed. Results 16 patients suffered from DMH, including 13 patients who had undergone pancreaticoduodenectomy, and 3 patients who had had resection of pancreatic body and tail. Gastrointestinal haemorrhage occurred in 6 patients, intra-abdominal haemorrhage occurred in 10 patients, respectively. Reoperations were performed in 11 patients, transcatheter arterial embolization （TAE） undertaken in 2 patients, and endoscopic treatment in 3 patients. 10 patients recovered after treatment, 6 patients （6/16） died. Conclusions The mortality of DMH after pancreatic surgery is high. Postoperative pancreatic leak and gastrointestinal stress ulcer are the most possible risk factors, intra-abdominal arterial haemorrhage is the main cause of death.

关 键 词：胰腺切除术 手术后出血 再手术 

分 类 号：R657.5[医药卫生—外科学]