胰十二指肠切除术后腹腔内迟发性出血的原因与处理

目的：探讨胰十二指肠切除术后迟发性腹腔内出血的原因与处理方法。
方法:回顾性分析168例施行胰十二指肠切除术的患者中术后腹腔内出血的情况。
结果:168例患者中有38例出现腹腔内迟发性出血，发生率为22.6%（38/168）；因大出血而再次手术止血11例，发生率6.5%（11/168）；再手术的病死率27.3%（3/11）；出血的主要原因是合并胰瘘或腹腔感染。
结论:胰十二指肠切除术后腹腔内出血与胰瘘或腹腔感染密切相关。完善围手术期的处理，预防与及时发现、积极处理胰瘘和腹腔感染可以减少腹腔内迟发性出血的发生。

The causes and treatment of delayed intra-abdominal hemorrhage after pancreatoduodenectomy

Objective:To study the causes and treatment of delayed intra-abdominal hemorrhage after pancreatoduodenectomy (PD).
Methods:The occurrence of intra-abdominal hemorrhage among the 168 patients undergoing PD was retropectively analyzed.
Results:Of the 168 post-PD patients, delayed intra-abdominal hemorrhage occured in 38 cases (22.6%, 38/168). Eleven patients underwent reoperation due to severe intra-abdominal bleeding, and the mortality rate in reoperated patients was 27.3% (3/11). Pancreatic fistula and abdominal infection were the major causes attributed to bleeding of post-PD patients.
Conclusions: The delayed intra-abdominal hemorrhage in post-PD patients is closely related with pancreatic fistula and abdominal infection. The incidence of delayed intra-abdominal hemorrhage can be reduced by the improvement of perioperative management, the prevention, early detection, and treatment of pancreatic fistula and abdominal infection.