胰十二指肠切除术相关消化道出血的诊治

摘要

目的 分析胰十二指肠切除术( pancreaticoduodenectomy,PD)后消化道出血并发症的常见原因,探讨相应临床诊治预防措施.方法 回顺性分析1998年1月至2010年1月本院外科收治并行PD治疗的331例壶腹周围疾病患者临床资料.结果 PD相关并发症发生率为37.2％,其中出血并发症发生率为6.7％,而消化道出血发生率为1.5％.PD常见消化道出血部位为胰肠吻合口出血(40.0％)、胃肠吻合口出血(20.0％),该组未发生胆肠吻合口出血.PD的消化道出血可发生在术中(20.0％)、术后24h内(20.0％)和术后24 h后(60.0％).术中出血的部位为胰肠吻合口胰腺断端,术后24 h内出血部位为胰肠吻合口空肠断端,术后24 h后出血部位为胃肠吻合口和空肠输出襻.PD后消化道出血的治疗手段包括:单纯开腹手术止血(40.0％)、血管介入后开腹手术止血(40.0％)、单纯血管介入栓塞止血(20.0％).结论 PD后消化道出血的常见部位在胰肠吻合口和胃肠吻合口,一线的诊断治疗手段为血管介入和栓塞.消化道内窥镜止血是可以选择的方式,而开腹手术止血是最终的治疗手段.%Objective To analyze the underlying causes of postoperative gastrointestinal (CI)bleeding after pancreaticoduodenectomy and to discuss the strategies in diagnosis,prevention and management.Methods The clinical data of 331 patients who were admitted to the Surgical Department of the First Hospital,Peking University from Jan. 1998 to Jan. 2010 was retrospectively analyzed.Results The overall postoperative morbidity was 37.2 ％,with a bleeding complication rate of 6.7 ％,and a GI bleeding rate of 1.5％.For postoperative GI bleeding,the main bleeding sites were from the pancreaticointestinal anastomosis (40.0％) and the gastrointestinal anastomosis (20.0％). Embolotherapy using vascular intervention alone (20.0％),open abdominal operation following vascular interventional therapy (40.0 ％ ) and open abdominal operation alone (40.0 ％ ) were used to control GIbleeding.Conclusions The common bleeding sites in the GI tract were at the pancreaticointestinal anastomosis and the gastrointestinal anastomosis. The main procedures used to control bleeding were embolization using vascular interventional therapy,endoscopic therapy and open abdominal therapy.