Post-pancreaticoduodenectomy Hemorrhage. Incidence, Diagnosis, and Treatment
Post-pancreaticoduodenectomy Hemorrhage. Incidence, Diagnosis, and Treatment
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DOI：
10.1007/s00268-011-1222-4
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发表时间：
2011-11-01
影响因子：
2.6
通讯作者：
Charco-Torra, R.
中科院分区：
文献类型：
--
作者：
Manas-Gomez, M. J.;Rodriguez-Revuelto, R.;Charco-Torra, R.
虽然胰十二指肠切除术（PD）后的死亡率已经下降，但发病率仍然很高，从30%到50%不等。在并发症中，出血最为突出；它与高死亡率有关，没有标准的管理。本研究的目的是分析我中心脑出血后帕金森病的发病率、诊断和治疗。方法2005年1月~ 2008年12月，对107例患者行PDs。我们从前瞻性数据库中对术后出血患者的特征进行了回顾性分析。分析了人口统计学资料、诊断、治疗（内科、剖腹手术、介入放射学）、与瘘管（胰腺或胆道）、腔内或腔外出血、出血时间（早期或晚期）、严重程度（中度/重度）和死亡率的关系。结果PD术后出血18例（18/107,16.82%）。18例患者中4例（22.2%）出现早期出血（< 24 h）， 13例（72%）出现重度出血。出血相关死亡率为11%(2/18)，住院死亡率为22.2%（4/18）。8/18例（44.4%）患者行动脉造影，6/8例（75%）有效；8/18行剖腹手术（44.4%）。18例患者中有5例在首次治疗后再次出血（27.8%）。观察到出血与瘘管之间的关联。结论胰腺切除术后出血是一种死亡率较高的并发症。应迅速诊断和治疗。胰腺和/或胆道瘘管与术后出血的高风险显著相关。介入放射学是一种很好的治疗选择。
Background Although mortality post-pancreaticoduodenectomy (PD) has decreased, morbidity rates continue to be high, ranging from 30% to 50%. Among complications, hemorrhage stands out; it is associated with high mortality and there is no standard management. The aim of the present study was to analyze the incidence, diagnosis, and treatment of hemorrhage post-cephalic PD at our center.Methods From January 2005 to December 2008, 107 PDs were performed. A retrospective review of characteristics of patients with postoperative hemorrhage was made from our prospective database. Demographic data, diagnosis, treatment (medical, laparotomy, interventional radiology), association with fistula (pancreatic or biliary), intra- or extraluminal hemorrhage, bleeding time (early or late), severity (moderate/severe), and mortality were analyzed.Results Eighteen patients (18/107; 16.82%) hemorrhaged after PD. Hemorrhage appeared early (< 24 h) in 4 of these 18 patients (22.2%), and it was severe in 13/18 (72%). Hemorrhage-related mortality was 11% (2/18) and hospital mortality was 22.2% (4/18). Arteriography was performed in 8/18 patients (44.4%) and was effective in 6/8 (75%); laparotomy was performed in 8/18 (44.4%). Re-bleeding occurred in 5 of these 18 patients after the first treatment (27.8%). An association between hemorrhage and fistula was observed.Conclusions Hemorrhage after pancreatic resection must be considered a complication with relatively high mortality. Diagnosis should be established and treatment applied rapidly. Pancreatic and/or biliary fistulae were significantly associated with a higher risk of postoperative hemorrhage. Interventional radiology is a good therapeutic option.