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.