胰十二指肠切除术后腹腔内出血的相关因素分析及预防策略
收稿日期: 2023-02-01
网络出版日期: 2024-09-03
基金资助
解放军联勤保障部队第九〇四医院院管课题(2018YG13)
Risk factors and prevention strategies for intraperitoneal hemorrhage after pancreaticoduodenectomy
Received date: 2023-02-01
Online published: 2024-09-03
目的：探讨胰十二指肠切除术后出血的相关因素及预防策略。方法：中国人民解放军联勤保障部队第九〇四医院肝胆外科2017年1月至2021年12月期间住院行胰十二指肠切除术的病人共计208例，其中出现术后出血21例，对其进行回顾性分析。结果：单因素分析表明，21例病人术后出血主要与胰漏、胆汁漏、腹腔感染、低蛋白血症、糖尿病、超声刀使用不当、骨骼化清扫、术中出血量、术前黄疸水平等有关（P<0.05），而与性别及年龄无关（P>0.05）。其中，4例经止血、输血等保守治疗后痊愈，6例行介入栓塞止血，11例行剖腹探查止血，其中2例术后出现多脏器功能衰竭死亡。胰漏（OR=3.963,95%CI: 1.120~14.025）、胆汁漏（OR=4.013,95% CI: 1.173~13.734）、腹腔感染（OR=7.545,95% CI: 1.833~31.051）是术后出血的独立危险因素。结论：不断提高吻合技术，减少吻合口漏，预防和控制腹腔感染，是预防胰十二指肠切除术后出血的主要措施。对术后出血保守治疗效果不佳的病人，应及时行手术治疗。
李伟 , 吴胜 , 田宇剑 , 唐晓明 , 蔡创 , 许志伟 . 胰十二指肠切除术后腹腔内出血的相关因素分析及预防策略[J]. 外科理论与实践, 2024 , 29(03) : 243 -248 . DOI: 10.16139/j.1007-9610.2024.03.10
Objective To investigate the risk factors and preventive strategies of pancreaticoduodenectomy postoperative hemorrhage. Methods A total of 208 patients who underwent pancreaticoduodenectomy in the Department of Hepatobiliary Surgery of the 904th Hospital of Joint Logistics Support Force, PLA from January 2017 to December 2021 were enrolled. Twenty-one patients with postoperative hemorrhage were retrospectively analyzed. Results Univariate analysis indicated that postoperative hemorrhage was mainly associated with pancreatic leakage, biliary leakage, abdominal infection, hypoproteinemia, diabetes, improper use of ultrasound knife, skeletonization, intraoperative blood loss, preoperative jaundice, etc.(P<0.05), but not gender and age (P>0.05). Among the 21 patients with postoperative hemorrhage, 4 cases recovered after conservative treatment such as hemostasis and blood transfusion, 6 cases underwent interventional treatment, 11 cases underwent abdominal exploration, and 2 cases died of postoperative multiple organ failure. Pancreatic leakage (OR=3.963,95%CI: 1.120-14.025), biliary leakage (OR=4.013,95% CI: 1.173-13.734) and abdominal infection (OR=7.545,95%CI: 1.833-31.051) were independent risk factors for postoperative hemorrhage. Conclusions The improvement of anastomotic manipulation, reduction of anastomotic leakage, and control and prevention of abdominal infection are important to prevent postoperative hemorrhage of pancreaticoduodenectomy. Surgical treatment should be performed as soon as possible for the patients with poor conservative treatment effect.
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