胰十二指肠切除术后晚期出血的原因及治疗  

Research on the risk factors and management of delayed hemorrhage after pancreatoduodenectomy

作　　者：林明飞 文钦夫 

机构地区：[1]海南省文昌市人民医院心胸甲乳外科,571300

出　　处：《临床外科杂志》2017年第10期749-751,共3页Journal of Clinical Surgery

摘　　要：目的探讨胰十二指肠切除术后晚期出血的影响因素及治疗策略。方法回顾性分析136例行胰十二指肠切除术的病人晚期出血的发生和治疗情况。结果 136例病人,发生晚期出血19例,发生率为14.0%(19/136);其中10例为重度出血,6例发生哨兵出血,5例死亡,病死率50%(5/10)。晚期出血病人的死亡原因主要是合并腹腔感染或并发多器官功能障碍(MODS)。结论胰十二指肠切除术后晚期出血的发生主要与假性动脉瘤、动脉破裂出血或胰腺残端出血有关,合并腹腔感染或并发MODS是导致病人死亡的主要原因;术前完善的准备、术中精细的操作和术后积极妥善的处理是预防和治疗胰十二指肠切除术后晚期出血的关键。Objective To investigate the risk factors and management of delayed hemorrhage after pancreatoduodenectomy.Methods A retrospective analysis of delayed hemorrhage after the pancreatoduodenectomy in 136 patients was performed.Results In 136 patients,delayed hemorrhage occurred in 19 cases,and the incidence rate was 14.0%（19/136）.10 cases was severe hemorrhage,and sentinel bleeding occurred in 6 cases,also 5 died due to the intra-abdominal infection and MODS.Conclusion Delayed hemorrhage after the pancreatoduodenectomy is closely related to pseudoaneurysm,bleeding due to arteriorrhexis,bleeding of the pancreas＇ stump.Meanwhile abdominal infection and MODS may be the main reason of the patients＇ death.Pre-operative preparation,best operation skills and proper post-operation management are the key points to the prevention and treatment of delayed hemorrhage.

关 键 词：胰十二指肠切除术 晚期出血 胰瘘 哨兵出血 

分 类 号：R656[医药卫生—外科学]