中国实用外科杂志

中国实用外科杂志

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伴临床相关性胰瘘的胰十二指肠切除术后出血临床特征与诊治分析

谭晓开，陈宏泽，李    乐，王拥卫，陈    华，孙    备   

  1. 哈尔滨医科大学附属第一医院胰胆外科  肝脾外科教育部重点实验室，黑龙江哈尔滨 150001
  • 出版日期:2020-02-01 发布日期:2020-02-14

  • Online:2020-02-01 Published:2020-02-14

摘要： 目的    探讨临床相关性胰瘘（CR-POPF）与胰十二指肠切除术（PD）后出血的关系，总结诊治及预防经验。方法回顾性分析2014年1月至2018年7月哈尔滨医科大学附属第一医院普外科收治的47例行PD术后发生出血病人临床资料，包括伴CR-POPF 30例和不伴CR-POPF 17例。治疗措施包括保守治疗、放射介入治疗、内镜治疗和手术治疗。结果    伴CR-POPF的30例PD术后出血病人均为迟发性出血，发生时间为术后13.8（3.0~37.0）d，其中B级胰瘘11例，C级胰瘘19例；消化道出血13例，腹腔出血18例（1例同时存在消化道和腹腔出血）；B级出血10例，C级出血20例；4例采取保守治疗，7例接受介入治疗，5例行胃镜检查治疗，11例行开放手术治疗，3例采用介入联合手术治疗。伴CR-POPF与不伴CR-POPF的PD术后出血病人在出血时间及分级，腹腔感染、腹腔引流时间、住院时间、ICU治疗时间以及病死率方面差异有统计学意义（P<0.05）。47例PD术后出血病人中17例死亡。结论    伴CR-POPF的PD术后出血病程长，病情复杂，病死率高。临床医生应高度重视，综合考虑各方面因素，选择合适的干预时机和治疗方式，进一步提高PD的安全性，降低病死率。

关键词: 胰十二指肠切除术, 术后出血, 胰瘘, 预防

Abstract: Clinical features，diagnosis and treatment of post-pancreaticoduodenectomy hemorrhage with concomitant clinically-related postoperative pancreatic fistula        TAN Xiao-kai，CHEN Hong-ze，LI Le，et al. Department of Pancreatic and Biliary Surgery，the First Affiliated Hospital of Harbin Medical University；Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin 150001，China
Corresponding author：SUN Bei，E-mail: sunbei70@tom.com
Abstract    Objective    To study the relationship between concomitant clinically-related postoperative pancreatic fistula (CR-POPF) and post-pancreaticoduodenectomy hemorrhage (PPH) and summarize the effective measures for diagnosis，treatment and prevention. Methods    The clinical data of 47 cases of PPH in Department of General Surgery, the First Affiliated Hospital of Harbin Medical University from January 2014 to July 2018 were analyzed retrospectively，including 30 with CR-POPF and 17 without CR-POPF. Treatment measures contained radiological intervention, gastrointestinal endoscopy，surgery and conservative treatment. Results    All the 30 patients with CR-POPF had delayed bleeding，and the average onset time was 13.8(3.0-37.0) days after  pancreaticoduodenectomy(PD). There were 11 cases of grade B and 19 cases of grade C pancreatic fistula. Thirteen patients had intraluminal hemorrhages.Eighteen cases had extraluminal bleeding，1 of which had both intraluminal and extraluminal hemorrhage. There were 10 cases of grade B and 20 cases of grade C PPH. In terms of treatment, 4 patients received conservative treatments, 7 patients received radiological interventions，5 patients received endoscopies, 11 patients received surgeries, and 3 patients received interventions together with surgeries. Compared with patients without CR-POPF, patients with CR-POPF had longer duration of abdominal drainage, hospital stay and ICU treatment, and showed higher risk of intraperitoneal infection. There also was an increasing tendency of in-hospital mortality in patients who had PPH with CR-POPF（P<0.05）. Seventeen patients died in 47 cases of hemorrhage after PD. Conclusion    Patients who have PPH with CR-POPF have longer duration of abdominal drainage，hospital stay，and high mortality. Clinicians should attach great importance to considering all factors, and selecting the appropriate intervention timing and treatment method, so as to further improve the safety of PD surgery and reduce the mortality.

Key words: pancreaticoduodenectomy, post-pancreatectomy hemorrhage, pancreatic fistula, prevention