Beyer Laura, Bonmardion Rémi, Marciano Sandrine, Hartung Olivier, Ramis Olivier, Chabert Lénaïk, Léone Marc, Emungania Olivier, Orsoni Pierre, Barthet Marc, Berdah Stéphane V, Brunet Christian, Moutardier Vincent
Department of Digestive Surgery, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord and Université de la Méditerranée, Chemin des Bourrely, 13915, Marseille Cedex 20, France.
J Gastrointest Surg. 2009 May;13(5):922-8. doi: 10.1007/s11605-009-0818-6. Epub 2009 Feb 18.
Hemorrhage after pancreaticoduodenectomy is a life-threatening complication, which occurs in 4% to 16% of cases, even in experienced centers. Many diagnostic and therapeutic options exist but no one has yet established management guidelines. This study aimed to determine the role of conservative management in delayed hemorrhage.
From January 2005 to August 2008, 87 patients underwent pancreaticoduodenectomy at our center. We reviewed, retrospectively, the medical charts of all patients who had experienced postoperative hemorrhage.
Early hemorrhage occurred in one patient, who underwent successful reoperation. Nine patients presented with delayed hemorrhage (10.3%), including three with sentinel bleeding. Mean onset was 20 days post-surgery. We used the same initial management for each patient: all had an urgent contrast computed tomography scan. In every case, the bleeding site was arterial. Conservative treatment (embolization or covered stent) was successful in every case. We reoperated on two patients for gastrointestinal perforation, at 9 days and 2 months after embolization, respectively. We transferred seven patients to an intensive care unit, with an average stay of 8 days. Mean hospital stay was 43 days (33-60). All patients survived.
Conservative management, combining endovascular procedures and aggressive resuscitation, is appropriate for most cases of delayed hemorrhage after pancreaticoduodenectomy.
胰十二指肠切除术后出血是一种危及生命的并发症，即使在经验丰富的中心，其发生率也为4%至16%。目前有多种诊断和治疗选择，但尚未建立管理指南。本研究旨在确定保守治疗在延迟性出血中的作用。
2005年1月至2008年8月，87例患者在本中心接受了胰十二指肠切除术。我们回顾性分析了所有术后出血患者的病历。
1例患者发生早期出血，再次手术成功。9例患者出现延迟性出血（10.3%），其中3例为哨兵出血。平均出血发生时间为术后20天。我们对每位患者采用相同的初始治疗方法：均进行了紧急增强CT扫描。每例患者的出血部位均为动脉。保守治疗（栓塞或覆膜支架置入）均获成功。2例患者分别在栓塞术后9天和2个月因胃肠道穿孔再次手术。7例患者转入重症监护病房，平均住院8天。平均住院时间为43天（33 - 60天）。所有患者均存活。
对于大多数胰十二指肠切除术后延迟性出血病例，结合血管内介入治疗和积极复苏的保守治疗是合适的。
