Department of Surgical Gastroenterology and Center for G.I. Bleed & Division of Hepato Biliary Pancreatic Diseases, Government Stanley Medical College Hospital, The Tamilnadu Dr. M.G.R. Medical University, Chennai, Tamilnadu, India.
HPB (Oxford). 2008;10(5):363-70. doi: 10.1080/13651820802247086.
OBJECTIVE & BACKGROUND DATA: Mortality following pancreatoduodenectomy (PD) has fallen below 5%, yet morbidity remains between 30 and 50%. Major haemorrhage following PD makes a significant contribution to this ongoing morbidity and mortality. The aim of the present study was to validate the new International Study Group of Pancreatic Surgery (ISGPS) Clinical grading system in predicting the outcome of post pancreaticoduodenectomy haemorrhage (PPH).
Between January 1998 and December 2007 a total of 458 patients who underwent Whipple's pancreaticoduodenectomy in our department were analysed with regard to haemorrhagic complications. The onset, location and severity of haemorrhage were classified according to the new criteria developed by an ISGPS. Risk factors for haemorrhage, management and outcome were analysed.
Severe PPH occurred in 14 patients (3.1%). Early haemorrhage (<24 hours) was recorded in five (36%) patients, and late haemorrhage (>24 hours) in nine (64%) patients. As per Clinical grading of ISGPS 7 (50%) belongs to Grade C and 7 (50%) belongs to Grade B. Haemostasis was attempted by surgery in 10 (71%) patients; angioembolisation was successful in two (14%) and endotherapy in one (7%) patient. The overall mortality is 29%(n=4). Age >60 years (p=0.02), sentinel bleeding (p=0.04), pancreatic leak (p=0.04) and ISGPS Clinical grade C (p=0.02) were associated with increased mortality.
Early haemorrhage was mostly managed surgically with better outcome when endoscopy is not feasible. Late haemorrhage is associated with high mortality due to pancreatic leak and sepsis. ISGPS Clinical grading of PPH is useful in predicting the outcome.
胰十二指肠切除术（PD）后的死亡率已降至 5%以下，但发病率仍在 30%至 50%之间。PD 后发生大出血是导致这种持续发病率和死亡率的重要原因。本研究旨在验证新的国际胰腺外科研究组（ISGPS）临床分级系统对预测胰十二指肠切除术后出血（PPH）结果的作用。
1998 年 1 月至 2007 年 12 月，我院共对 458 例行胰十二指肠切除术的患者进行了分析，观察出血并发症。根据 ISGPS 制定的新标准，对出血的发生、位置和严重程度进行分类。分析出血的危险因素、处理方法和结果。
14 例（3.1%）发生严重 PPH。5 例（36%）为早期出血（<24 小时），9 例（64%）为晚期出血（>24 小时）。根据 ISGPS 的临床分级，7 例（50%）为 C 级，7 例（50%）为 B 级。10 例（71%）患者尝试手术止血；2 例（14%）患者血管栓塞成功，1 例（7%）患者内镜治疗成功。总的死亡率为 29%（n=4）。年龄>60 岁（p=0.02）、首发出血（p=0.04）、胰漏（p=0.04）和 ISGPS 临床分级 C 级（p=0.02）与死亡率增加相关。
早期出血大多通过手术治疗，当内镜治疗不可行时，手术效果较好。晚期出血与胰漏和感染性休克相关，死亡率较高。PPH 的 ISGPS 临床分级有助于预测结果。
