胰十二指肠切除术后出血的危险因素及其治疗

doi:10.6040/j.issn.1671-7554.0.2018.652

摘要/Abstract

摘要： 目的探讨胰十二指肠切除术后出血(PPH)的危险因素及治疗策略。方法回顾性分析自2005年1月1日至2017年12月31日在南方医科大学南方医院行胰十二指肠切除术(PD)424例患者临床病例资料,探讨发生PPH的危险因素及治疗策略。单因素分析及多因素分析分别采用卡方检验和Logistic回归模型。结果行PD 424例患者中,发生PPH 60例,总共死亡9例,死亡率为 2.12%(9/424),其中因出血导致死亡6例。单因素分析结果显示,合并高血压、胰瘘、胆瘘、腹腔感染是PPH的相关危险因素(χ2分别为7.832、28.491、7.086、25.378,P<0.05),Logistic多因素分析结果提示,合并高血压、腹腔感染、胰瘘是PPH的独立危险因素(OR分别为2.242、3.068、2.953,95%CI分别为1.169~4.300、1.501~6.274、1.491~5.849,P<0.05)。结论合并高血压、腹腔感染、胰瘘是PPH的独立危险因素,围术期维持血压稳定,减少发生腹腔感染及胰瘘,是预防发生PPH的关键。发生PPH后,治疗策略选择应根据出血时间、部位及其严重程度决定。

关键词: 胰十二指肠切除术, 术后出血, 危险因素, 治疗

Abstract: Objective To explore the risk factors and treatment strategies of postpancreatoduodenectomy hemorrhage(PPH). Methods The clinical data of 424 patients who underwent pancreatoduodenectomy(PD)during Jan. 1, 2005 and Dec. 31, 2017 were retrospectively analyzed to evaluate the risk factors and treatment strategies of the occurrence of PPH. The chi-square test and logistic regression were used for univariate and multivariate analyses. Results PPH occurred in 60 patients, 9 of whom died, and the mortality was 2.12%(9/424). Of these 9 patients, 6 died due to hemorrhage. Univariate analysis showed that complications such as hypertension, pancreatic fistula, biliary fistula, and intra-abdominal infection were related risk factors of PPH(χ²=7.832, 28.491, 7.086, 25.378, respectively, P<0.05). Logistic multivariate analysis showed that complications such as hypertension, intra-abdominal infection and pancreatic fistula were independent risk factors of PPH(OR=2.242,3.068, 2.953, respectively, 95%CI=1.169-4.300, 1.501-6.274, 1.491-5.849, respectively, P<0.05). Conclusion Complicated hypertension, pancreatic fistula, and intra-abdominal infection are the independent risk factors of PPH. The keys to prevent PPH are to maintain stable blood pressure, reduce pancreatic fistula and intra-abdominal infection perioperatively. In case of PPH, the choice of treatment strategies should be determined according to the onset, location and severity of hemorrhage.

Key words: Pancreatoduodenectomy, Postoperative hemorrhage, Risk factor, Treatment

中图分类号:

R619+.1

王春明,刘钦成,郭凌宏,廖彩仙. 胰十二指肠切除术后出血的危险因素及其治疗[J]. 山东大学学报 (医学版), 2019, 57(1): 81-86.

WANG Chunming, LIU Qincheng, GUO Linghong, LIAO Caixian. Risk factors and treatment of hemorrhage after pancreatoduodenectomy[J]. Journal of Shandong University (Health Sciences), 2019, 57(1): 81-86.

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