论文部分内容阅读
目的 分析胰十二指肠切除术(PD)术后出血(PPDH)的总体危险因素,并根据PPDH临床特征进行亚组分类分析,指导PPDH的个体化及精准化诊治策略.方法 回顾性分析2009年9月至2015年3月中山大学孙逸仙纪念医院普外科行PD手术患者的临床资料,并根据出血时间、部位、严重程度、出血级别等进行亚组统计,分析PPDH相关危险因素.结果 247例患者纳入统计,PPDH发生率12.55％(31/247),早期出血10例(32.26％),晚期出血21例(67.74％);单纯消化道出血14例(45.16％),单纯腹腔出血11例(35.48％),两者均有6例(19.35％);轻微出血4例(12.90％),严重出血27例(87.10％);A级0例(0％),B级5例(16.13％),C级26例(83.87％).出血死亡4例,病死率12.90％,占总体死亡患者的50％.单因素分析显示术前高血清总胆红素(TBIL)水平、术后胰漏及腹腔感染为PPDH的危险因素,多因素分析显示三者均为PPDH独立危险因素.亚组分析显示,早期出血以腹腔出血多见.结论 术前高TBIL水平、术后胰漏及腹腔感染是PPDH的危险因素,也是PPDH的独立危险因素,早期出血应警惕腹腔出血的可能.“,”Objective To investigate the overall risk factors of PPDH together with a subgroup analysis for different clinical conditions,and provide strategies for diagnosis and treatment of PPDH individually and precisely.Methods Clinical data of pancreaticoduodenectomy (PD) patients in the Department of General Surgery,Sun-Yat-Sen Memorial Hospital of Sun-Yat-Sen University from September 2009 to March 2015 were analyzed retrospectively.Overall risk-factor analysis of PPDH was conducted,and a subgroup analysis was conducted subsequently according to the time,sites,severity,and grading of hemorrhage.Results A total of 247 patients were included.The incidence of PPDH was 12.55％ (31/247).Among them,10 patients were early PPDH (32.26％),21patients were late PPDH (67.74％);14 patients had intraluminal PPDH (45.16％),11patients had extraluminal PPDH (35.48％),and six patients had both intraluminal and extraluminal PPDH (19.35％);and four patients had mild PPDH (12.90％),and 27 had severe PPDH (87.10％).No patients had Grade A PPDH (0％),five had Grade B PPDH (16.13％),and 26 had Grade C PPDH (83.87％).Four patients died of PPDH (12.90％),which accounted for 50％ of the whole died patients.Univariate analysis showed that high level of serum bilirubin,postoperative pancreatic fistula (POPF),and intrabdominal infection were risk factors of PPDH.Multivariate analysis showed that all of them were independent risk factors.Subgroup analysis showed that extraluminal PPDH was more frequent in early PPDH group.Conclusions High bilirubin serum level,POPF,and intrabdominal infection were independent risk factors of PPDH.It should be aware of intrabdominal PPDH for early PPDH.