胰十二指肠切除术后腹腔迟发性大出血因素分析与处理  

Analysis and treatment of delayed intra-abdominal hemorrhage after pancreatoduodenectomy

作　　者：朱艳志 马海霞 周猛 兰明银 江斌 

机构地区：[1]十堰市太和医院(湖北医药学院附属医院)肝胆胰外科诊疗中心,湖北十堰442000

出　　处：《临床外科杂志》2017年第8期614-616,共3页Journal of Clinical Surgery

摘　　要：目的探讨胰十二指肠切除术(PD)后腹腔迟发性大出血因素分析与处理。方法回顾性分析138例病人行胰腺十二指肠切除术诊治过程及体会。结果 138例病人中术后发生胰漏并大出血者11例,发生率为7.97%(11/138),11例出血病人中,因大出血经DSA介入治疗4例,发生率2.89%(4/138),因大出血再次手术止血7例,发生率5.07%(7/138),再次手术后死亡3例,病死率27.27%(3/11),出血主要原因为胰漏腐蚀腹腔动静脉血管引起大出血。结论胰十二指肠切除术后腹腔迟发性大出血主要是胰漏腐蚀胰肠吻合口周围血管出血所致。介入治疗和手术治疗是PD术后胰漏合并迟发性腹腔出血的重要手段。Objective To explore the causes and treatment of delayed intra-abdominal hemorrhage after pancreatoduodenectomy（ PD）. Methods We retropectively summarized the experience and process for the occurrence of intra-abdominal hemorrhage among 138 patients undergoing PD. Results Of the 138 post-PD patients,delayed intra-abdominal hemorrhage occured in 11 cases 7. 97%（ 11/138）. 11 patients underwent reoperation due to DSA interventional treatment for severe hemorrhage 4 cases,the incidence of 2. 89%（ 4/138）,severe intra-abdominal bleeding occured in 11 cases 5. 07%（ 7/138）,and the mortality rate in reoperated patients was 27. 27%（ 3/11）,Pancreatic fistula corrosion intraperitoneal arteriovenous was the major cause attributed to bleeding of post-PD patients. Conclusion The delayed intra-abdominal hemorrhage in post-PD patients is closely related with pancreatic fistula corrosion intraperitoneal arteriovenous. Intervention and surgical treatment is an important way for pancreatic fistula complicated with delayed intraabdominal bleeding after pancreaticoduodenectomy.

关 键 词：胰十二指肠切除术 术后大出血 迟发性 胰漏 

分 类 号：R656[医药卫生—外科学]