胰十二指肠切除术后出血的治疗及相关因素分析  

Treatment and related factors analysis of postpancreaticoduodenectomy hemorrhage

作　　者：陈建锋[1] 宫琳[1] 矫学黎[1] 袁伟升[1] 

机构地区：[1]解放军第四0一医院肝胆外科,青岛266071

出　　处：《中华消化外科杂志》2016年第10期992-998,共7页Chinese Journal of Digestive Surgery

基　　金：全国博士后科研基金（2013M542516）

摘　　要：目的：探讨胰十二指肠切除术后出血（PPH）的诊断和治疗方法以及PPH的危险因素和预后因素。方法：采用回顾性病例对照研究方法。收集2008年1月至2013年7月解放军第四○一医院收治的703例行胰十二指肠切除术患者的临床资料。胰头及壶腹部恶性肿瘤行标准胰十二指肠切除术，良性肿瘤及十二指肠乳头肿瘤行保留幽门的胰十二指肠切除术。PPH采用对应的治疗方法。观察指标：（1）手术情况（手术方式、手术时间、术中出血量）。（2）PPH的诊断。（3）PPH的治疗情况。（4）影响PPH发生的危险因素进行单因素和多因素分析。（5）影响PPH患者预后的危险因素进行单因素和多因素分析。正态分布的计量资料以±s表示，偏态分布的计量资料以M（范围）表示。单因素分析采用χ2检验或Fisher确切概率法，多因素分析采用Logistic回归模型。结果：（1）手术情况：703例患者中，行标准胰十二指肠切除术409例，保留幽门的胰十二指肠切除术294例；其中联合右半肝切除术1例，门静脉重建27例，肝动脉重建2例。胰肠吻合采用胰管空肠黏膜对黏膜吻合658例，胰肠套入式吻合45例。胰管内常规放置支撑管，内引流598例，外引流105例。胆肠吻合全部采用胆总管空肠端侧吻合。胃肠吻合采用胃空肠侧侧吻合409例，十二指肠空肠端侧吻合294例。703例患者手术时间为（324±54）min，术中出血量为（428±118）mL。（2）PPH的诊断：703例患者行胰十二指肠切除术后，62例发生PPH，其中明确出血原因38例，出血原因不明确24例（A级5例、B级17例、C级2例）。①出血部位：腔外出血27例，腔内出血28例，腔内＋腔外出血7例。②出血时间：早期出血5例，迟发性出血57例。患者首次出血中位时间为术后11 d（6 h～59 d）。③出血量：术后出血量为（885±253）mL。轻度出血30例，重度出血32例Objective：To explore the diagnosis, treatment, risk factors and prognosis factors of postpancreaticoduodenectomy hemorrhage （PPH）. Methods：The retrospective casecontrol study was adopted. The clinical data of 703 patients who underwent pancreatoduodenectomy at Hospital 401 of the People′s Liberation Army from January 2008 to July 2013 were collected. Standard pancreatoduodenectomy was carried out for the malignant tumors of the head of pancreas or ampulla, pyloruspreserving pancreatoduodenectomy was operated for the benign tumor or the duodenal papilla tumor. The corresponding treatment was adopted for PPH. The observation indicators included： （1） the surgical situation （surgical method, operation time and the volume of intraoperative blood loss）, （2） diagnosis of PPH, （3） treatment of PPH, （4） univariate and multivariate analyses for the risk factors affecting the occurrence of PPH, （5） univariate and multivariate analyses for the risk factors affecting prognosis of PPH patients. The measurement data with normal distribution were represented as ±s. The measurement data with skewed distribution were represented as M （range）. The chisquare test or Fisher exact probability was used for univariate analysis. Logistic regression model was used for multivariate analysis. Results： （1） The surgical situation： among 703 patients, 409 patients underwent standard pancreatoduodenectomy and 294 underwent pyloruspreserving pancreatoduodenectomy, including 1 combined with right hemihepatectomy, 27 with portal vein reconstruction and 2 with hepatic artery reconstruction. Pancreaticojejunostomy was applied to 658 patients using mucosa anastomosis of the pancreatic duct to jejunum and 45 patients using invagination anastomosis. Supporting tube was routinely deposed in the pancreatic duct, 598 patients had internal drainage and 105 patients had external drainage. The endtoside anastomosis between common bile duct and jejunum was used for choledochojejunostomy. The 409 patients rece

关 键 词：胰腺肿瘤 胰十二指肠切除术 危险因素 预后因素 

分 类 号：R656[医药卫生—外科学]