Abstract:

Analysis of risk factors for prognosis of postoperative hemorrhage after pancreaticoduodenectomy: a report of 60 cases        ZHU Qi-cong，WU Peng-fei，LU Zi-peng，et al. Pancreas Center，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China
Corresponding authors：JIANG Kui-rong，E-mail：jiangkuirong@njmu.edu.cn；MIAO Yi，E-mail：miaoyi@njmu.edu.cn
Abstract    Objective    To analyze common risk factors and treatment strategy for prognosis of postoperative hemorrhage after pancreaticoduodenectomy. Methods    The clinical data of 60 patients who underwent pancreaticoduodenectomy in the First Affiliated Hospital of Nanjing Medical University from January 1，2012 to December 31，2015 were analyzed retrospectively. The risk factors for prognosis of postoperative hemorrhage were analyzed. Results    Among them, 8 patients died after surgery，others were alive. Early bleeding appeared in 10 patients and delayed hemorrhage occurred in 50 patients. Bleeding site included 23 gastrointestinal hemorrhage patients and 37 abdominal hemorrhage patients. Mild bleeding occurred in 37 patients and severe bleeding in 23 patients. Among them, 3 patients were grade A，40 patients grade B，17 patients grade C. Postoperative complications included postoperative pancreatic fistula in 28 patients，intra-abdominal infection in 5 patients and biliary fistula in 3 patients. Treatment strategies contained 41 patients with bleeding were treated conservatively, 9 patients received endoscopy or angioembolization while 10 patients underwent reoperation. Intra-abdominal infection and bleeding degree were important risk factors of clinical outcomes of hemorrhage after pancreaticoduodenectomy. ROC curve analysis showed that the 5th day of after surgery was a clear demarcation point of clinical prognosis. Conclusion    Intra-abdominal infection, bleeding degree and grade are important risk factors of hemorrhage after pancreaticoduodenectomy. The 5th day after surgery may be a clear demarcation point of clinical prognosis, which has certain significance for the bleeding grade.

Key words: pancreaticoduodenectomy, postoperative hemorrhage, intra-abdominal infection, pancreatic fistula, biliary fistula

摘要：

目的    探讨胰十二指肠切除术后出血病人预后相关危险因素及治疗策略。方法    回顾性分析2012-01-01至2015-12-31南京医科大学第一附属医院收治的60例胰十二指肠切除术后发生出血病人的临床资料，分析影响发生术后出血病人预后的相关危险因素。结果    术后出血相关死亡8例。早期出血10例，迟发性出血50例；出血部位位于消化道内23例，腹腔内37例；轻度出血37例，重度出血23例；出血等级A级3例，B级40例，C级17例。合并胰瘘28例，腹腔感染5例，胆瘘3例。术后出血单纯行保守治疗41例，行内镜或介入治疗9例，再手术治疗10例。合并腹腔感染、重度出血和出血等级高是影响胰十二指肠切除术后发生出血病人预后的重要危险因素。ROC曲线分析发现，发生出血距手术5 d是临床预后的明显分界点。结论    腹腔感染、出血严重程度和出血等级是影响胰十二指肠切除术后出血死亡的重要因素；发生出血距手术5 d是临床预后的明显分界点，对术后出血早晚期分界有一定意义。

关键词: 胰十二指肠切除术, 术后出血, 腹腔感染, 胰瘘, 胆瘘