腹腔镜胰十二指肠切除术后晚期出血的临床特征及处理策略  

Clinical characteristics and management strategies of late bleeding after laparoscopic pancreaticoduodenectomy

作　　者：李秋生[1] 张泽嘉 邢中强 何伟 赵伟红[1] 刘鹏翔 刘瑞斌 张建生[1] 路文彦[1] 刘建华[1] Li Qiusheng;Zhang Zejia;Xing Zhongqiang;He Wei;Zhao Weihong;Liu Pengxiang;Liu Ruibin;Zhang Jiansheng;Lu Wenyan;Liu Jianhua(Department of Heptobiliary Surgery,Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of General Surgery II,Neiqiu Hospital of Traditional Chinese Medicine,Xingtai 054200,China)

机构地区：[1]河北医科大学第二医院肝胆外科,石家庄050000 [2]内丘县中医院外二科,邢台054200

出　　处：《中华肝胆外科杂志》2023年第8期589-593,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：河北省重点研发计划(20377772D)。

摘　　要：目的观察分析腹腔镜胰十二指肠切除术(LPD)术后晚期出血的临床特征及处理策略。方法回顾性分析2018年3月至2022年3月河北医科大学第二医院肝胆外科收治的58例胰十二指肠切除术后出血(PPH)患者的临床资料,其中男性42例,女性16例,年龄(61.88±11.02)岁,年龄范围34~86岁。根据有无腹腔内侵蚀因素(胰瘘、胆瘘、胃肠吻合口瘘、腹腔内脓肿)分为两组:侵蚀组(n=42)和非侵蚀组(n=16)。所有患者均行标准淋巴结清扫术,收集患者的出血间隔时间、再出血情况、结局等临床资料,总结并分析这两种PPH的临床特征及处理策略。结果侵蚀组和非侵蚀组PPH患者LPD至出血的时间间隔分别为8.00(5.00,19.25)d和21.50(12.75,26.75)d,差异有统计学意义(P=0.001)。侵蚀组和非侵蚀组患者在LPD术后1个月内均可出现出血。42例侵蚀组患者手术治疗31例(73.81%),保守治疗9例(21.43%),介入治疗2例(4.76%);16例非侵蚀组手术治疗5例(31.25%),保守治疗4例(25.00%),介入治疗7例(43.75%)。与非侵蚀组相比,侵蚀组患者再次出血的比例增加[47.6%(20/42)比12.5%(2/16)],差异具有统计学意义(P<0.05)。侵蚀组与非侵蚀组PPH患者的临床表现、出血位置、严重程度及结局间差异均具有统计学意义(均P<0.05)。结论腹腔内侵蚀因素的存在会影响LPD术后晚期出血的临床特征及治疗方式。手术是PPH治疗的主要方式,应作为处理PPH的紧急和最终选择。Objective To study the clinical characteristics and management strategies of late bleeding after laparoscopic pancreaticoduodenectomy(LPD).Methods The clinical data of 58 patients with post-pancreaticoduodenectomy hemorrhage(PPH)admitted to the Department of Hepatobiliary Surgery of the Second Hospital of Hebei Medical University from March 2018 to March 2022 were retrospectively analyzed,including 42 males and 16 females,aged(61.88±11.02)years old.According to the occurrence of intra-abdominal erosion factors(e.g.,pancreatic fistula,biliary fistula,gastrointestinal anastomotic fistula,intra-abdominal abscess),patients were divided into the erosion group(n=42)and non-erosion group(n=16).All patients underwent standard lymphadenectomy.Clinical data including the PPH time-point,occurrence of rebleeding,and treatment outcomes were accessed.The management strategies of PPH in the two groups of patients were analyzed.Results The PPH time-point in the erosion group and non-erosion patients was 8.00(5.00,19.25)d and 21.50(12.75,26.75)d,respectively(P=0.001).PPH can occurred within one month after surgery in both erosion and non-erosion groups.In the erosion group,31 cases(73.81%,31/42)were treated by re-operation,two(4.76%,2/42)by interventional radiology and nine(21.43%,9/42)with conservative protocol,respectively.In the non-erosion group,five cases(31.25%,5/16)were treated by re-operation,seven(43.75%,7/16)by interventional radiology and four(25.00%,4/16)with conservative protocol,respectively.The incidence of re-bleeding is higher in the erosion group[47.6%(20/42)vs 12.5%(2/16),P<0.05].Clinical manifestations,sites and severity of bleeding,and treatment outcomes were also different in the erosion and non-erosion groups(all P<0.05).Conclusions The occurrence of intra-abdominal erosion factors can affect the clinical characteristics and treatment strategy of late bleeding after laparoscopic pancreaticoduodenectomy.Surgery remains the treatment of choice for post-pancreaticoduodenectomy hemorrhage either as an urgent o

关 键 词：腹腔镜检查 侵蚀性因素 胰十二指肠切除术 术后出血 

分 类 号：R735[医药卫生—肿瘤]