胰十二指肠切除术后出血的临床分析

目的探讨胰十二指肠切除术后出血的原因及防治方法。方法回顾性分析2000年1月至2012年12月我院192例胰十二指肠切除术患者的临床资料。结果胰十二指肠切除术后出血共20例，发生率为10．4％。其中腹腔出血9例（早期4例，晚期5例），消化道出血11例（早期4例，晚期7例）。20例患者中死亡6例，死亡率为30％。胰瘘和腹腔感染患者术后出血的发生率较无胰瘘和腹腔感染的患者高（P〈0．05）。结论胰十二指肠切除术后出血的发生率和死亡率仍较高。合理的术中及术后处理，术后预防和控制胰瘘、腹腔感染及应激性溃疡是减少术后出血的关键，应根据出血的部位、时间和严重程度采取相应的止血措施。

Clinical analysis of hemorrhage after pancreaticoduodenectomy

Objective To explore the cause, prevention and treatment of post pancreaticoduodenectomy （PD） hem- orrhage. Methods The clinical data of 192 patients who underwent PD in our hospital between January 2000 and De- cember 2012 were retrospectively analyzed. Results The incidence of postoperative hemorrhage was 10.4% （20/192） , the mortality caused by this complication was 30% （ 6/20 ）. Among these patients, intra - abdominal hemorrhage oc- curred in 9 cases （4 and 5 cases of early and delayed hemorrhage respectively）. Gastrointestinal hemorrhage occurred in 11 eases （4 and 7 cases of early and delayed hemorrhage respectively）. The proportion of postoperative hemorrhage with pancreatic fistula and abdominal infection was higher than that without pancreatic fistula and abdominal infection. Con- clusoin The incidence and mortality of hemorrhage after PD is still high. Reasonable intraoperative and postoperative management, prevention and control of pancreatic fistula, infection and stress ulcer are the key points for reducing post- operative hemorrhage. Proper treatments s~ould be used according to the site, onset and severity of hemorrhage.