胰十二指肠切除术后迟发出血的影响因素及处理策略分析  

Analysis of the influencing factors and treatment strategy of delayedhemorrhage after pancreaticoduodenectomy

作　　者：林天生[1] 陈忠[1] LIN Tiansheng;CHEN Zhong(Department of Hepatobiliary and Pancreatic Surgery,Shengli Clinical Medical College of Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建省立医院肝胆胰外科,福州350001

出　　处：《临床外科杂志》2020年第9期867-870,共4页Journal of Clinical Surgery

摘　　要：目的分析胰十二指肠切除术后出现迟发出血的相关因素,探讨迟发出血的处理策略。方法 2015年1月~2020年1月我院行胰腺十二指肠切除术的病人276例,迟发出血25例,对术后迟发出血相关因素行单因素和多因素分析,找出迟发出血的危险因素。结果 276例病人中出现迟发出血25例(9.1%),迟发出血组与无出血组的年龄、胰管直径、是否胰瘘、是否胆漏、是否腹腔感染比较,差异有统计学意义(P<0.05),年龄≥60岁、胰管直径≥3 mm、胰瘘和胆漏是迟发出血的独立因素,其中胰管直径≥3 mm为保护因素,其余3个为危险因素。结论迟发出血病因复杂,病死率高,需要有经验的胰腺治疗中心及多学科的联合治疗,对出血、再出血的及时和恰当的治疗是降低死亡率的关键。Objective To observe and analyze the related factors of delayed hemorrhage after pancreaticoduodenectomy and to explore the management strategy of delayed hemorrhage.Methods Reviewing 276 patients who underwent pancreaticoduodenectomy in Fujian Provincial Hospital from January 2015 to January 2020,univariate and multivariate analyses were performed on delayed hemorrhage related factors and treatment strategies were discussed.Results The incidence of delayed hemorrhageis 9.1%(25/276),Among them,there were differences in age,pancreatic duct diameter,pancreatic fistula,bile leakage,and abdominal infection between the delayed hemorrhage group and the non-hemorrhage group(P<0.05).While age ≥60,pancreatic duct diameter ≥3 mm,pancreatic fistula and biliary leakage are independent factors of delayed hemorrhage.Pancreatic duct diameter ≥3 mm is a protective factor,and the remaining three are risk factors.Conclusion The cause of delayed hemorrhage is complicated and the mortality is high.It requires an experienced pancreatic treatment center and multidisciplinary combined treatment.Timely and appropriate treatment of hemorrhage and rehemorrhage is the key to reducing mortality.

关 键 词：胰十二指肠切除术后迟发出血 胰瘘 介入治疗 急诊手术 

分 类 号：R657.5[医药卫生—外科学]