肝胆胰术后迟发性出血的诊治分析

目的 探讨肝胆胰术后迟发性出血的原因和诊断治疗方法。方法 回顾性分析宁夏回族自治区人民医院2015年1月至2022年3月收治的13例肝胆胰腺术后出血患者的临床资料和诊治方法，总结其出血的原因和治疗经验。结果 13例患者均有失血性休克临床表现，其中8例为消化道出血：7例为肝动脉分支假性动脉瘤破裂，1例为胆道出血；5例腹腔出血。13例患者动脉造影明确出血部位后行出血部位动脉栓塞治疗，12例出血停止痊愈。另1例患者动脉栓塞治疗失败后，行开腹行肝右动脉结扎止血术后止血。结论 假性动脉瘤形成、胰漏和腹腔感染是肝胆胰患者术后迟发性出血的主要原因。血管造影术是诊断患者术后出血重要的检查方法，动脉栓塞术是治疗术后出血的有效方法。

Diagnosis and treatment of delayed postoperative hemorrhage after hepatobiliary and pancreatic surgery

Objective To summarize the causes, diagnosis and treatment of delayed postoperative hemorrhage in patients undergone hepatobiliary and pancreatic surgery. Methods The clinical data, diagnosis and treatment methods of 13 patients performed hepatobiliary and pancreatic postoperative hemorrhage treated in Ningxia Hui Autonomous Region People’s Hospital from Jan. 2015 to Mar. 2022 were reviewed, and the causes and treatment experience of hemorrhage were summarized. Results Thirteen patients presented with hemorrhagic shock and hemorrhage. Gastrointestinal bleeding was noted in 8 patients including pseudoaneurysmal rupture of hepatic artery branches (n=7) and hemobilia (n=1). Intra-abdominal hemorrhage was observed in the other 5 patients. All patients were treated by arterial embolization. Bleeding was stopped in twelve patients. One patient underwent right hepatic artery ligation following failure of embolization. Conclusion The main causes of delayed hemorrhage after hepatobiliary and pancreatic surgery were pseudoaneurysm, pancreatic leakage and intra-abdominal infection. Artery angiography is an important examination method to diagnose postoperative bleeding, and arterial embolization is an effective method to treat postoperative bleeding.