中国实用外科杂志

中国实用外科杂志

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胰腺术后出血预防及诊治研究（附518例胰腺手术分析）

姜脉涛，宋增福，姜洪池，孙    备，白雪巍   

  1. 哈尔滨医科大学第一临床医学院胰胆外科，黑龙江哈尔滨150001
  • 出版日期:2015-03-01 发布日期:2015-03-02

  • Online:2015-03-01 Published:2015-03-02

摘要：

目的    观察针对胰腺术后出血（postpancreatectomy hemorrhage，PPH）术中及术后采取特定的预防及治疗措施的效果，并探讨PPH的病因、诊断及治疗。方法    回顾性分析哈尔滨医科大学附属第一医院2008—2013年收治的518例胰腺手术病人资料，分为前期组（2008年1月至2010年12月，267例）和近期组（2011年1月至2013年12月，251例）。主要的预防及治疗措施为：(1)胰管支架管外引流；（2）黎式引流管的应用及摆放；（3）关注前哨出血；（4）术后强化冲洗。结果    518例胰腺手术的PPH发生率为8.1%；早期出血在病因、出血部位、严重程度、治疗方式和预后上与晚期出血差异有统计学意义（P＜0.05）；与前期组比较，近期组PPH在发生率（5.6% vs. 10.5%，P=0.041）、C级出血病例比例（7.1% vs. 46.4%，P=0.028）、治疗方式及预后等方面差异均有统计学意义；近期组胰瘘发生率低于前期组（17.9% vs. 25.5%，P=0.038）；近期组前哨出血发生率为9.2%，其中14例合并胰瘘，11例前哨出血病人最终发生PPH。结论    早期PPH出血原因多为技术层面，应及时手术治疗，预后好；晚期出血病因复杂，病情重，病死率高，需多学科联合治疗。关注前哨出血，针对PPH采取积极地预防及治疗措施，可以降低其发生率及危害。

关键词: 胰腺术后出血, 胰瘘, 前哨出血

Abstract:

Prevention, diagnosis and treatment of postpancreatectomy hemorrhage：A retrospective analysis of 518 patients        JIANG Mai-tao，SONG Zeng-fu，JIANG Hong-chi，et al. Department of Pancreatic and Biliary Surgery，the First Affiliated Hospital of Harbin Medical University，Harbin 150001，China
Corresponding author：BAI Xue-wei，E-mail：baixuewei78@163.com
Abstract    Objective    To observe the effect of specific prevention and treatment measures for postpancreatectomy hemorrhage (PPH) in the intraoperative and postoperative period， and explore the etiology，diagnosis and treatment of PPH. Methods    The clinical data of 518 patients underwent pancreatic surgery in the First Affiliated Hospital of Harbin Medical University between 2008 and 2013 were analyzed retrospectively. The patients were devided into two groups：previous (from January 2008 to December 2010，267 cases) and recent group (from January 2011 to December 2013，251 cases)，according to whether to adopt prevention and treatment measures for PPH or not. The main prevention and treatment measures for PPH were as follows：(1) external stent drainage of the pancreatic duct；(2) application of LI's drainage tube；(3) pay attention to sentinel bleed；(4) strengthen rinse after surgery. Results    The incidence of PPH in 518 patients was 8.1%. There were statistically significant differences in etiology，sites of bleeding，severity of PPH，treatment and prognosis between early and late hemorrhage (P<0.05). Compared with previous data，the recent group had significant differences in the incidence of PPH (5.6% vs. 10.5%，P=0.041)，proportion of C-level hemorrhage patients (7.1% vs. 46.4%，P=0.028)，treatment and prognosis. Pancreatic fistula rate in the recent group was lower than the previous group（17.9% vs. 25.5%，P=0.038）. The incidence of sentinel bleed in the recent group was 9.2%，of which 14 patients complicating with pancreatic fistula，and 8 patients who had sentinel bleed finally developed postpancreatectomy hemorrhage. Conclusion    The causes of early PPH are mostly from the technical level. With prompt surgical treatment，the prognosis of PPH is good. Late hemorrhage is more severe，has more complex conditions and a higher mortality rate，and requires multidisciplinary treatment. Paying attention to sentinel bleed and application of prevention and treatment measures for PPH can reduce its incidence and damage.

Key words: postpancreatectomy hemorrhage, pancreatic fistula, sentinel bleed