中国实用外科杂志

中国实用外科杂志 ›› 2010, Vol. 30 ›› Issue (02): 108-110.

• 论著 • 上一篇    下一篇

胰腺手术后出血危险因素分析（附236例报告）

宋军民，邢宝才   

  1. 北京大学临床肿瘤学院 北京肿瘤医院暨北京市肿瘤防治研究所肝胆胰肿瘤外一科，北京 100142
  • 出版日期:2010-02-01 发布日期:2010-03-11

  • Online:2010-02-01 Published:2010-03-11

PDF

1176

摘要：

目的    研究胰腺手术后出血（PPH）的相关因素、诊断及治疗。方法    对2003?2007年北京大学临床肿瘤学院北京肿瘤医院胰腺手术的临床资料进行分析，对术后并发症进行分类统计，就出血相关因素、临床表现、处理方法与结果进行分析。结果    236例中33例发生PPH，其中栓塞治疗4例，手术治疗7例，内镜止血1例，死亡6例，其余均行内科保守治疗。 结论    PPH与腹腔积液、胰瘘、手术方式等因素相关，与病人性别、年龄、病理类型、是否有胃排空障碍、是否术前减黄、胰腺吻合方式等因素无关。胰瘘发生后需早期引流、冲洗，预防出血。根据不同出血类型选择处理方式，尽量行血管造影检查，明确出血部位并行初步处理。

关键词: 胰腺手术后出血, 胰瘘, 止血

Abstract:

Analysis of risk factors for post pancreatectomy hemorrhage: a report of 236 cases        SONG Jun-min，XING Bao-cai.  Department of Hepatobiliary & Pancreatic Surgery Unit Ⅰ, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing 100142, China
Corresponding  author ：XING Bao-cai，E-mail：xingbaocai88@sina.com
Abstract    Objective    To investigate the risk factors, diagnosis and treatment for post pancreatectomy hemorrhage（PPH）. Methods    The clinical data of patients performed pancreatic surgery between 2003 and 2007 at Beijing Cancer Hospital were analyzed retrospectively. The data included bleeding risk factors, clinical presentation, management and outcome.  Results    Among 236 cases, PPH occurred in 33 cases. Four of 33 cases were performed angiography and embolism. Seven cases performed surgery. One case performed endoscopy. Six cases died. Others performed medical treatment.  Conclusion    Pyoperitoneum, pancreatic fistula and surgery choice are important factors in the pathogenesis of PPH, other than factors such as sex, age, pathology, delayed gastric emptying, etc. Early drain is essential after pancreatic fistula. Angiography should be considered firstly to confirm the bleeding source.

Key words: post pancreatectomy hemorrhage, pancreatic fistula；hemostasia