胰十二指肠切除术中及术后出血的处理

目的:探讨胰十二指肠切除术中及术后出血的原因和处理措施。方法:回顾性分析260例行胰十二指肠切除术患者的临床资料。结果:术中发生大出血12例,主要出血原因为门静脉、肠系膜上静脉（10例）和肠系膜上动脉损伤（2例）;经处理后仅死亡1例。术后发生大出血26例,主要原因为胰胃吻合口出血（17例）和胃空肠吻合口出血（9例）;死亡1例。结论:仔细的术前评估和精细的手术技术是避免术中大出血的关键。用血管外科技术和材料处理术中大出血可能获得较好的止血效果。提高手术技术,加强围手术期处理,可减少术后出血的发生。

The management of operative and postoperative bleeding of pancreatoduodenectomy

Objective To discuss the causes and treatment methods for operative and postoperative bleeding of pancreatoduodenectomy.Methods The clinical data of 260 cases of pancreatoduodenectomy were retrospectively analysed.Results Twelve cases had massive bleeding during the operation and one patient died. The primary cause of bleeding was the injury of portal vein or superior mesenteric vein(10 cases) and superior mesenteric artery(2 cases).26 cases had massive postoperative bleeding and one patient died.The main causes were pancreaticogastrostomic anastomosis bleeding (17 cases) and gastrojejunostomic anastomosis bleeding(9 cases).Conclusions Careful preoperative assessment and meticulous surgical procedure are the key points to avoid severe bleeding during operation. The use of vascular surgical materials and techniques can effectively control severe bleeding during operation. Improvement of operative technique and peri-operative treatment can reduce the incidence of postoperative bleeding.