• 1. 上海交通大學(xué)醫(yī)學(xué)院附屬新華醫(yī)院普外科(上海 200092);;
  • 2. 上海第二軍醫(yī)大學(xué)附屬長海醫(yī)院外科(上海 200433);

目的  探討胰十二指腸切除術(shù)后出血的危險因素及治療方法。
方法  回顧性分析2009年5月至2011年10月期間上海交通大學(xué)醫(yī)學(xué)院附屬新華醫(yī)院 78例胰十二指腸切除術(shù)患者的臨床資料。
結(jié)果  78例患者中術(shù)后發(fā)生出血者8例,發(fā)生率為10.3%。8例出血病例中,腹腔出血2例(早期和晚期各1例);消化道出血6例
(早期1例,晚期5例)。單因素分析顯示術(shù)中出血量、術(shù)后腹腔感染、胰瘺及胰胃吻合為術(shù)后出血的危險因素;多因素分析顯示胰胃吻合、術(shù)后腹腔感染和胰瘺為獨立危險因素。
結(jié)論  確切的手術(shù)、術(shù)后預(yù)防胰瘺和控制腹腔感染是減少術(shù)后出血的關(guān)鍵,應(yīng)根據(jù)出血的部位、時間和嚴(yán)重程度采取相應(yīng)的止血措施。預(yù)防其發(fā)生是關(guān)鍵。

引用本文: 顧鈞,吳文廣,丁琦晨,楊佳華,李茂嵐,張林,陸建華,董平,畢建威,劉穎斌. 胰十二指腸切除術(shù)后出血的危險因素及其診治. 中國普外基礎(chǔ)與臨床雜志, 2012, 19(6): 653-656. doi: 復(fù)制

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2. Beger HG, Gansauge F, Sehwarz M, et a1. Pancreatic head resection:the risk for local and systemic complications in 1 315 patients——a monoinatitutional experience [J]. Am J Surg, 2007,194(4S):S16-S19.
3. Brodsky JT, Turnbull AD. Arterial hemorrhage after pancreatoduodenectomy.The‘sentinel bleed’ [J]. Arch Surg, 1991,126(8):1037-1040.
4. Yekebas EF, Wolfram L, Cataldegirmen G, et a1. Postpancreatectomy hemorrhage:diagnosis and treatment:an analysis in 1 669 consecutive pancreatic resections [J]. Ann Surg, 2007,246(2):269-280.
5. 樓文暉, 王單松, 匡天濤, 等. 胰十二指腸切除術(shù)后出血 [J].中華普通外科雜志, 2008, 23(11):886-887.
6. Blanc T, Cortes A, Goere D, et a1. Hemorrhage after pancreaticoduedenectomy:when is surgery still indicated? [J]. Am JSurg, 2007, 194(1):3-9.
7. Choi SH, Moon HJ, Heo JS, et a1. Delayed hemorrhage afterpancreaticoduodenectomy [J]. J Am Coll Surg, 2004, 199(2):.
8. Tien YW, Lee PH, Yang CY, et a1. Risk factors of massivebleeding related to pancreatic leak after pancreaticoduodenectomy[J]. J Am Coll Surg, 2005, 201(4):554-559.
9. Puppala S, Patel J, McPherson S, et a1. Hemorrhagic complicationsafter Whipple surgery: imaging and radiologic intervention[J]. AJR Am J Roentgenol, 2011, 196(1):192-197.
10. Camerlo A, Turrini O, Marciano S, et a1. Delayed arterial hemorrhageafter pancreaticoduodenectomy is conservation of hepaticarterial flow vital? [J]. Pancreas, 2010, 39(2):260-262.
11. Sanjay P, Fawzi A, Fulke JL, et a1. Late post pancreatectomyhaemorrhage. Risk factors and modern management [J]. JOP,.
12. Wang ZJ, Wang MQ, Liu FY, et a1. Role of interventional endovasculartherapy for delayed hemorrhage after pancreaticoduodenectomy[J]. Chin Med J (Engl), 2010, 123(21):3110-3117.
13. Schäfer M, Heinrich S, Pfammatter T, et a1. Managementof delayed major visceral arterial bleeding after pancreatic surgery[J]. HPB (Oxford), 2011, 13(2):132-138.
14. 劉穎斌, 王建偉, 方河清, 等. 捆綁式胰腸吻合術(shù)在胰十二指腸切除術(shù)中的應(yīng)用 [J]. 中華醫(yī)學(xué)雜志, 2004, 84(12):997-.
15. 劉穎斌, 許斌錢, 浩然, 等. 捆綁式胰腸吻合術(shù)在胰十二指腸切除術(shù)中的應(yīng)用 [J]. 臨床外科雜志, 2004, 12(4):212-214.
16. -191.
17. .
18. , 11(3):220-225.
  1. 1. Wente MN, Veit JA, Bassi C, et a1. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition [J]. Surgery, 2007, 142(1):20-25.
  2. 2. Beger HG, Gansauge F, Sehwarz M, et a1. Pancreatic head resection:the risk for local and systemic complications in 1 315 patients——a monoinatitutional experience [J]. Am J Surg, 2007,194(4S):S16-S19.
  3. 3. Brodsky JT, Turnbull AD. Arterial hemorrhage after pancreatoduodenectomy.The‘sentinel bleed’ [J]. Arch Surg, 1991,126(8):1037-1040.
  4. 4. Yekebas EF, Wolfram L, Cataldegirmen G, et a1. Postpancreatectomy hemorrhage:diagnosis and treatment:an analysis in 1 669 consecutive pancreatic resections [J]. Ann Surg, 2007,246(2):269-280.
  5. 5. 樓文暉, 王單松, 匡天濤, 等. 胰十二指腸切除術(shù)后出血 [J].中華普通外科雜志, 2008, 23(11):886-887.
  6. 6. Blanc T, Cortes A, Goere D, et a1. Hemorrhage after pancreaticoduedenectomy:when is surgery still indicated? [J]. Am JSurg, 2007, 194(1):3-9.
  7. 7. Choi SH, Moon HJ, Heo JS, et a1. Delayed hemorrhage afterpancreaticoduodenectomy [J]. J Am Coll Surg, 2004, 199(2):.
  8. 8. Tien YW, Lee PH, Yang CY, et a1. Risk factors of massivebleeding related to pancreatic leak after pancreaticoduodenectomy[J]. J Am Coll Surg, 2005, 201(4):554-559.
  9. 9. Puppala S, Patel J, McPherson S, et a1. Hemorrhagic complicationsafter Whipple surgery: imaging and radiologic intervention[J]. AJR Am J Roentgenol, 2011, 196(1):192-197.
  10. 10. Camerlo A, Turrini O, Marciano S, et a1. Delayed arterial hemorrhageafter pancreaticoduodenectomy is conservation of hepaticarterial flow vital? [J]. Pancreas, 2010, 39(2):260-262.
  11. 11. Sanjay P, Fawzi A, Fulke JL, et a1. Late post pancreatectomyhaemorrhage. Risk factors and modern management [J]. JOP,.
  12. 12. Wang ZJ, Wang MQ, Liu FY, et a1. Role of interventional endovasculartherapy for delayed hemorrhage after pancreaticoduodenectomy[J]. Chin Med J (Engl), 2010, 123(21):3110-3117.
  13. 13. Schäfer M, Heinrich S, Pfammatter T, et a1. Managementof delayed major visceral arterial bleeding after pancreatic surgery[J]. HPB (Oxford), 2011, 13(2):132-138.
  14. 14. 劉穎斌, 王建偉, 方河清, 等. 捆綁式胰腸吻合術(shù)在胰十二指腸切除術(shù)中的應(yīng)用 [J]. 中華醫(yī)學(xué)雜志, 2004, 84(12):997-.
  15. 15. 劉穎斌, 許斌錢, 浩然, 等. 捆綁式胰腸吻合術(shù)在胰十二指腸切除術(shù)中的應(yīng)用 [J]. 臨床外科雜志, 2004, 12(4):212-214.
  16. 16. -191.
  17. 17. .
  18. 18. , 11(3):220-225.