胰十二指肠切除术相关消化道出血的诊治

摘要

Objective To analyze the causes and clinical features of gastrointestinal hemorrhage following pancreaticoduodenectomy (PD),and to provide the management strategies for this complication.Methods The clinic data of 412 patients who underwent PD from January 2000 to April 2010 was retrospectively reviewed.There were 232 male and 180 female patients,average age was (60 ±12) years.The mode of procedure was standard PD and the Child's reconstruction of digestive tract,whose anastomosic steps encluded gastroenterostomy following chlangioenterostomy and pancreaticoenterostomy,was employed.Etiology of gastrointestinal haemorrhage,diagnostic methods and treatment strategy was recorded and analyzed.Results The postoperative mobidity was 37.1％ (153/412),the rate of haemorrhagic complications was 6.6％ (27/412),and gastrointestinal hemorrhage was recorded in 11 patients (2.7％).The bleeding rate of pancreaticointestinal anastomosis and gastricointestinal anastomosis were 5/11 and 4/11,respectively.Among these 11 patients,early hemorrhage occurred in 6 patients,7 patients were due to technical failure.In order to control this kind of complication,open abdominal operation alone was performed on 4 patients,endoscopic management was performed on 3 patients and succeeded in 2 patients,vascular interventional therapy was performed on 5 patients and succeeded in 2 patients,and Re-laparotomy following vascular interventional therapy was performed on 2 patients successfully.Conclusions Gastrointestinal hemorrhage following PD always occurred in early stage and reliable hemostasis during operation is the key points for prevention.Angiography is minimally invasive and holds the diagnostic value.Timely and decisive reoperation is an important method to management of postoperative gastrointestinal hemorrhage.%目的 分析胰十二指肠切除术后消化道出血的病因和临床特点,提出相应的临床诊治措施.方法 回顾性研究2000年1月至2010年4月412例接受胰十二指肠切除术患者的临床资料,其中男性232例,女性180例,平均年龄(60±12)岁.手术方式为标准胰十二指肠切除,消化道重建采取Child顺序进行胰肠、胆肠和胃肠吻合,分析术后消化道出血临床特点和诊治方法.结果 本组胰十二指肠切除术相关并发症发生率为37.1％ (153/412),出血发生率为6.6％(27/412),其中消化道出血发生率为2.7％(11/412).常见消化道出血部位为胰肠吻合口5例,胃肠吻合口出血4例.早期出血者6例,7例患者出血为医源性因素直接导致.本组直接行开腹手术止血4例；胃镜检查3例,2例治疗成功；DSA检查5例,2例成功止血,血管介入后开腹手术止血2例.结论 胰十二指肠切除术后消化道出血常发生在术后早期,术中完善止血能预防多数创面出血,血管造影具有微创和确诊价值,出血后果断手术探查效果良好.