Risk factors and treatment of hemorrhage after pancreatoduodenectomy
- WANG Chunming, LIU Qincheng, GUO Linghong, LIAO Caixian
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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.