[1]曹子谦,李树营△,任宏,等.胰十二指肠切除术后出血的治疗及影响因素分析[J].陕西医学杂志,2018,(11):1434-1437.
　Cao Ziqian,Li Shuying,Ren Hong,et al.Analysis of the effect and treatment methods of pancreatic leakage and intra-abdominal infection on PPH[J].,2018,(11):1434-1437.
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胰十二指肠切除术后出血的治疗及影响因素分析
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
期数:
2018年11期
页码:
1434-1437
栏目:
临床研究
出版日期:
2018-11-29

文章信息/Info

Title:
Analysis of the effect and treatment methods of pancreatic leakage and intra-abdominal infection on PPH
文章编号:
0.3969/j.issn.1000-7377.2018.11.020
作者:
曹子谦1; 2; 李树营2△; 任宏3; 刘海珠1
1.陕西省榆林市第一医院普外科（榆林719000 ），2.陕西省榆林市横山区人民医院普外科（榆林719100），3.西安交通大学第一附属医院肿瘤外科（西安710061）
Author(s):
Cao Ziqian;  Li Shuying;  Ren Hong;  et al.
Department of General Surgery, First Hospital of Yulin City in Shaanxi Province (Yulin 719000)
关键词:
胰十二指肠切除术出血危险因素腹腔感染胰液漏
Keywords:
PancreatodenectonyHemorrhageRisk factorsIntra-abdominal infectionPancreatic leakage
分类号:
R657.5
文献标志码:
A
摘要:
目的：分析胰液漏和腹腔感染对胰十二指肠切除术后出血（PPH）的影响及治疗方法。方法：对170例行胰十二指肠切除术（PD）患者的临床资料进行回顾性分析。记录患者标准PD（壶腹部与胰头恶性肿瘤者）、保留幽门胰十二指肠切除术（PPPD）（十二指肠乳头肿瘤与良性肿瘤）的例数，并对发生PPH者进行治疗。采用单因素分析与多因素Logistic回归分析患者发生PPH的影响因素。结果：170例患者中，行标准PD治疗者98例（57.65%），行PPPD术72例（42.35%）。170例患者中，平均术中出血量为（417.94±101.35）ml，平均手术时间为（316.97±47.96）min。170例患者中，出现发生PPH者16例（9.41%），其中出血原因不明6例，出血原因明确10例；早期出血5例，迟发性出血11例。对16患者给予补充血容量、输血、补液、抑酸、血管造影栓塞等对症支持治疗。单因素分析结果发现，血管切除重建、伴有高血压病、术后腹腔感染、术后胰液漏是患者发生PPH的影响因素（均P＜0.05）。多因素Logistic回归分析结果发现，术后腹腔感染、术后胰液漏是患者发生PPH的影响因素（均P＜0.05）。结论：术后腹腔感染与胰液漏是行PD术患者发生PPH的影响因素，迟发性出血的治疗效果差于早期出血，而血管造影栓塞是迟发性出血患者的重要治疗方法。
Abstract:
Objective: To analyze the influence of pancreatic leakage and intra-abdominal infection on postpancreaticoduodenectomy hemorrhage (PPH) and the treatment methods. Methods: The clinical data of 170 cases of pancreatoduodenectomy (PD) treated in our hospital were retrospectively analyzed. The number of patients with standard PD (ampullary and pancreatic head malignant tumor), pylorus-preserving pancreatoduodenectomy (PPPD) (duodenal papillary tumor and benign tumor) was recorded, and the patients with PPH were treated. Univariate analysis and multivariate Logistic regression analysis were used to analyze the influencing factors of PPH in patients. Results: Among the 170 patients, 98 cases (57.65%) were treated with standard PD, and 72 cases (42.35%) underwent PPPD. In the 170 patients, the mean intraoperative blood loss was (417.94±101.35) ml, and the mean operative time was (316.97±47.96) min. Of the 170 patients, there were 16 cases of PPH (9.41%), of which 6 were unknown causes of bleeding, 10 were bleeding causes; 5 were early bleeding and 11 were delayed bleeding. 16 patients were given symptomatic supportive treatment including blood volume, blood transfusion, fluid infusion, acid suppression and angiography embolization. The results of single factor analysis showed that vascular resection and reconstruction, hypertension, postoperative intra-abdominal infection, and postoperative pancreatic leakage were the factors affecting the incidence of patients with PPH (P＜0.05). Multivariate Logistic regression analysis showed that postoperative intra-abdominal infection and postoperative pancreatic leakage were the influencing factors of PPH (P＜0.05). Conclusion: Postoperative intra-abdominal infection and pancreatic fluid leakage are the factors affecting the incidence of PPH in patients treated with PD. The therapeutic effect of delayed hemorrhage is less than early bleeding, and angiographic embolization is an important treatment for patients with delayed hemorrhage.

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更新日期/Last Update: 2018-11-30