Risk factors and prevention strategies for intraperitoneal hemorrhage after pancreaticoduodenectomy

doi:10.16139/j.1007-9610.2024.03.10

Abstract

Abstract:

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.

Key words: Pancreaticoduodenectomy, Postoperative bleeding, Related factors, Prevention

CLC Number:

LI Wei, WU Sheng, TIAN Yujian, TANG Xiaoming, CAI Chuang, XU Zhiwei. Risk factors and prevention strategies for intraperitoneal hemorrhage after pancreaticoduodenectomy[J]. Journal of Surgery Concepts & Practice, 2024, 29(03): 243-248.

Figures/Tables 4

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References 20

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Indicator	Group	Postoperative hemorrhage		χ² value	P value
Indicator	Group	Yes(n=21)	No(n=187)	χ² value	P value
Age	<60 years	9(42.9)	104(55.6)	1.238	0.266
	≥60 years	12(57.1)	83(44.4)
Sex	Female	9(42.9)	87(46.5)	0.102	0.749
	Male	12(57.1)	100(53.5)
Mean post- operative serum glucose levels	≥10 mmol/L	13(61.9)	73(39.0)	4.071	0.044
Mean post- operative serum glucose levels	<10 mmol/L	8(38.1)	114(61.0)
Postoperative hypoproteinemia	<30 g/L	13(61.9)	70(37.4)	4.715	0.030
Postoperative hypoproteinemia	≥30 g/L	8(38.1)	117(62.6)
Skeletonization	Yes	13(61.9)	67(35.8)	5.424	0.020
	No	8(38.1)	120(64.2)
Pancreatic leakage	Yes	16(76.2)	82(43.9)	7.925	0.005
Pancreatic leakage	No	5(23.8)	105(56.1)
Biliary leakage	Yes	14(66.7)	76(40.6)	5.209	0.022
	No	7(33.3)	111(59.4)
Abdominal infection	Yes	17(81.0)	94(50.3)	7.143	0.008
Abdominal infection	No	4(19.0)	93(49.7)
Improper use of ultrasound knife	Yes	14(66.7)	74(39.6)	5.678	0.017
Improper use of ultrasound knife	No	7(33.3)	113(60.4)
Intraoperative blood loss	≥800 mL	13(61.9)	72(38.5)	4.279	0.039
Intraoperative blood loss	<800 mL	8(38.1)	115(61.5)
Preoperative total bilirubin	≥171 mmol/L	16(76.2)	90(48.1)	5.949	0.015
Preoperative total bilirubin	<171 mmol/L	5(23.8)	97(51.9)

Item	Indicator	Assignment
Dependent variable	Postoperative hemorrhage	Yes=1, No=2
Independent variable	Sex	Male=1, Female=0
	Age	Under 60 years old=1, No less than 60 years old=2
	Mean postoperative serum glucose levels	≥10 mmol/L=1, <10 mmol/L=2
	Postoperative hypoproteinemia	<30 g/L=1, ≥30 g/L=2
	Skeletonized lymph node dissection	Yes=1, No=2
	Pancreatic leakage	Yes=1, No=2
	Biliary leakage	Yes=1, No=2
	Abdominal infection	Yes=1, No=2
	Improper use of ultrasound knife	Yes=1, No=2
	Intraoperative blood loss	≥800 mL=1, <800 mL=2
	Preoperative total bilirubin	≥171 mmol/L=1, <171 mmol/L=2

Item	B	SE	wald	P value	OR value（95%CI）
Mean postoperative serum glucose levels	0.726	0.565	1.651	0.199	2.068(0.683-6.262)
Postoperative hypoproteinemia	1.032	0.618	2.792	0.095	2.807(0.836-9.420)
Skeletonized lymph node dissection	0.737	0.568	1.681	0.195	2.089(0.686-6.362)
Pancreatic leakage	1.377	0.645	4.562	0.033	3.963(1.120-14.025)
Biliary leakage	1.390	0.628	4.901	0.027	4.013(1.173-13.734)
Abdominal infection	2.021	0.722	7.838	0.005	7.545(1.833-31.05)
Improper use of ultrasound knife	1.015	0.580	3.069	0.080	2.761(0.886-8.598)
Intraoperative blood loss	0.990	0.603	2.698	0.100	2.691(0.826-8.768)
Preoperative total bilirubin	1.163	0.635	3.354	0.067	3.199(0.922-11.107)