摘要
目的探讨胰十二指肠切除术（PD）术后消化道出血的原因及治疗。方法对我院1996年1月至2011年12月213例PD患者和2例由外院转入的PD术后消化道出血患者的临床资料进行回顾性分析。结果213例PD共出现术后消化道出血18例，发生率8．5％（18／213）。18例患者中4例死亡，病死率22．2％（4／18）。在20例消化道出血病例（我院的18例和外院转入的2例）中，应激性溃疡为最常见的出血原因（11例，55％）。轻度出血8例，均通过内科药物治疗止血；重度出血12例，其中7例接受了再次手术。单因素分析显示手术时间≥420min（χ2=3．976，P=0．046）和术中出血量≥1200ml（χ2=6．753，P=0．009）与术后应激性溃疡出血有关，多因素分析显示只有术中出血量为独立危险因素（OR=5．677，P=0．035）。结论消化道出血是PD术后的常见并发症之一。术中熟练操作，减少出血量，有助于减少术后应激性溃疡出血的发生。在内科治疗效果不佳时，应及时再手术止血，根据出血的原因和部位采取适当的手术方式。
Objective To analyze the cause and treatment of the postoperative gastrointestinal hemorrhage after pancreaticoduodenectomy （PD）. Methods Clinical data of 213 patients who underwent PD in our hospital from January 1996 to December 2011 and 2 patients who suffered from gastrointestinal hemorrhage after PD transferred to our hospital from other hospitals were retrospectively analyzed. Results The incidence of postoperative gastrointestinal hemorrhage was 8.5% （ 18/213 ）, the mortality rate of which was 22. 2% （ 4/18 ）. Among the twenty patients with postoperative gastrointestinal hemorrhage （including the 2 patients transferred from other hospitals） ,stress ulcer was the most common reason of gastrointestinal hemorrhage （11/20,55%）. There were 8 patients suffering from mild hemorrhage who were treated by medications. Seven of 12 patients who suffered from severe hemorrhage underwent reoperation. Univariate analysis showed that duration of operation above 420 min （χ2 = 3. 976, P = 0. 046 ） and volume of intraoperative blood loss above 1200 ml（ χ2 = 6. 753, P = 0. 009） were significantly associated with postoperative stress ulcer bleeding. Multivariate logistic regression analysis showed that intraoperative blood loss was the only independent factor associated with postoperative stress ulcer bleeding （ OR = 5. 677, P = 0. 035 ） . Conclusion Gastrointestinal hemorrhage is one of the common complications after PD. The incidence of stress ulcer bleeding could be reduced by skilfful operation and decreasing intraoperative blood loss. Operation should be used properly according to the cause and location of bleeding if hemorrhage could not be stopped by medications.
出处
《中国综合临床》
2013年第5期542-546,共5页
Clinical Medicine of China
