Blanc Thomas, Cortes Alexandre, Goere Diane, Sibert Annie, Pessaux Patrick, Belghiti Jacques, Sauvanet Alain
Department of Digestive Surgery, AP-HP, Hospital Beaujon, 100 Bd du Général Leclerc, 92118 Clichy-Cedex, France.
Am J Surg. 2007 Jul;194(1):3-9. doi: 10.1016/j.amjsurg.2006.08.088.
This study analyzed presentation and management of hemorrhage after pancreaticoduodenectomy (PD) to determine the respective role of surgery and embolization.
From January 1992 to March 2005, 411 patients underwent PD and were analyzed with regard to postoperative hemorrhage.
Hemorrhage occurred in 27 patients (7%), either within the first 3 postoperative days ("early" hemorrhage, n = 11) or after day 8 ("delayed" hemorrhage, n = 16, including 4 with "sentinel" bleeding). At the time of bleeding, 12 patients (44%) (all with delayed hemorrhage) had associated abdominal complications. Two patients had successful conservative treatment. Two stable patients with pseudoaneurysm, diagnosed by computed tomography scan, underwent successful embolization. Four patients with active bleeding underwent unsuccessful angiography. Overall, 23 patients were reoperated on without any completion pancreatectomy, 3 rebled, and 3 (11%) died (including 2 with delayed hemorrhage).
Both embolization and surgery have a role in the management of hemorrhage after PD. For early hemorrhage, reoperation is appropriate. In case of sentinel bleeding, pseudoaneurysms can be detected by computed tomography scan and treated by embolization. For delayed active hemorrhage, reoperation is still indicated.
本研究分析了胰十二指肠切除术（PD）后出血的表现及处理方式，以确定手术和栓塞各自的作用。
1992年1月至2005年3月，411例患者接受了PD手术，并对术后出血情况进行了分析。
27例患者（7%）发生出血，其中11例在术后3天内（“早期”出血），16例在术后第8天之后（“延迟”出血，包括4例“哨兵”出血）。出血时，12例患者（44%）（均为延迟出血）伴有腹部并发症。2例患者保守治疗成功。2例经计算机断层扫描诊断为假性动脉瘤且病情稳定的患者，栓塞治疗成功。4例活动性出血患者血管造影失败。总体而言，23例患者再次手术，均未行全胰切除术，3例再次出血，3例（11%）死亡（包括2例延迟出血患者）。
栓塞和手术在PD术后出血的处理中均有作用。对于早期出血，再次手术是合适的。对于哨兵出血，可通过计算机断层扫描检测假性动脉瘤并进行栓塞治疗。对于延迟性活动性出血，仍需再次手术。
