目的 分析胰十二指肠切除术后出血的部位、原因,探讨相应的预防策略.方法 回顾性分析四川大学华西医院胰腺外科2015年1月到2017年6月共220例实施胰十二指肠切除术患者的临床资料.结果 220例患者中发生术后出血18例(8.18%),包括早期出血3例,迟发性出血15例,治愈14例,死亡4例.单因素分析表明:术前胆红素水平、术中骨骼化清扫、术后胰瘘为术后出血的危险因素(P<0.05);Logistic回归多因素分析确定2个独立危险因素与出血有关:术前胆红素水平(OR=8.221),术后胰瘘(OR=8.015).结论 胰十二指肠切除术后出血的危险因素为术前胆红素≥171umol/L及术后胰瘘.因此,降低术前黄疸水平,早期发现并处理胰瘘能有效减少术后出血的发生.%Objective To analyze the location and reason of hemorrhage after pancreaticoduodenecto-my, and discuss the prevention strategy. Methods The clinical data of 220 patients who underwent pancreati-coduodenectomy were analyzed retrospectively from January 2015 to June 2017 in the pancreatic surgery depart-ment of huaxi hospital of sichuan university. Results Of all patients,18(8. 18%) patients had hemorrhage,a-mong whom 3 patients had grade early hemorrhage,15 patients had delayed hemorrhage,and 14 patients were cured,4 patients were died. Univarlate analysis showed that the preoperative bilirubin, skeletization procedure, pancreatic fistula were significantly associated with postoperative hemorrhage ( P < 0 . 05 ) . Multivariate analy-sis using logistic regression identified for vailables as independent factors associated with postoperative hemor-rhage, namely, preoperative bilirubin and pancreatic fistula. Conclusion The independent risk factors for postoperative hemorrhage after PD are preoperative bilirubin more than or equal to 171μmol/L and pancreatic fistula. Thus, reduce preoperative bilirubin level, early detection and treatment of pancreatic fistula can effec-tively decrease postoperative hemorrhage after PD.
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