胰十二指肠术后出血9例诊疗体会

    Diagnosis and treatment of post-pancreaticoduodenectomy hemorrhage: a report of 9 cases

    • 摘要: 目的:探讨胰十二指肠切除(PD)术后出血的原因、诊断、治疗及预防。方法:回顾性分析9例PD术的临床资料。术后出血的诊断采用国际胰腺外科研究协作组的胰腺切除术后出血定义及分级标准。结果:9例中早期出血3例,迟发性出血6例;轻度出血2例,重度出血7例;消化道出血7例,腹腔内出血2例;再次手术5例,介入治疗1例,保守治疗3例;病死2例。结论:早期出血应积极急诊手术探查;迟发性出血如保守治疗无效应急诊手术;精细熟练的解剖、严密吻合、术中彻底止血、有效预防吻合口漏等并发症可有效减少术后出血;介入动脉栓塞可用于迟发性出血的诊治。

       

      Abstract: Objective:To explore the causes diagnosis,treatment and prevention of haemorrhage after pancreaticoduodenectomy(PD).Methods:The clinical data of 9 patients undergoing PD were retrospectively analyzed.The diagnosis of haemorrhage was made according to the definition and classification of postpancreatectomy haemorrhage(PPH)proposed by the international study group of the pancreatic surgery.Results:Early PPH occurred in 3 cases and delayed PPH in 6 cases;mild PPH was observed in 2 cases and severe PPH in 7 cases including 7 intraluminal PPH and 2 extraluminal PPH;5 patients received reoperation,1 patient emergency selective arterial embolism and 3 patients conservative therapy;2 patients died.Conclusions:Timely operation is essential for management of early PPH;delayed haemorrhage failed by conservative therapy should resort to emergency operation;meticulousoperative techniques,complete hemostasis and effective prevention of postoperative complications such as stomal leak could significantly reduce the occurrence of PPH.Selective arterial embolism might be employed for treatment of delayed hemorrhage.

       

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