Department of HBP Surgery and Transplant, Hospital Universitari Vall d'Hebrón, Autonomous University of Barcelona, Passeig Vall d'Hebrón 119-129, 08035, Barcelona, Spain.
World J Surg. 2011 Nov;35(11):2543-8. doi: 10.1007/s00268-011-1222-4.
Although mortality post-pancreaticoduodenectomy (PD) has decreased, morbidity rates continue to be high, ranging from 30% to 50%. Among complications, hemorrhage stands out; it is associated with high mortality and there is no standard management. The aim of the present study was to analyze the incidence, diagnosis, and treatment of hemorrhage post-cephalic PD at our center.
From January 2005 to December 2008, 107 PDs were performed. A retrospective review of characteristics of patients with postoperative hemorrhage was made from our prospective database. Demographic data, diagnosis, treatment (medical, laparotomy, interventional radiology), association with fistula (pancreatic or biliary), intra- or extraluminal hemorrhage, bleeding time (early or late), severity (moderate/severe), and mortality were analyzed.
Eighteen patients (18/107; 16.82%) hemorrhaged after PD. Hemorrhage appeared early (< 24 h) in 4 of these 18 patients (22.2%), and it was severe in 13/18 (72%). Hemorrhage-related mortality was 11% (2/18) and hospital mortality was 22.2% (4/18). Arteriography was performed in 8/18 patients (44.4%) and was effective in 6/8 (75%); laparotomy was performed in 8/18 (44.4%). Re-bleeding occurred in 5 of these 18 patients after the first treatment (27.8%). An association between hemorrhage and fistula was observed.
Hemorrhage after pancreatic resection must be considered a complication with relatively high mortality. Diagnosis should be established and treatment applied rapidly. Pancreatic and/or biliary fistulae were significantly associated with a higher risk of postoperative hemorrhage. Interventional radiology is a good therapeutic option.
尽管胰十二指肠切除术（PD）后的死亡率有所下降，但发病率仍居高不下，范围在 30%至 50%之间。在并发症中，出血尤为突出；它与高死亡率相关，目前尚无标准的治疗方法。本研究旨在分析我们中心 PD 术后发生的出血的发生率、诊断和治疗。
2005 年 1 月至 2008 年 12 月，共进行了 107 例 PD。我们从前瞻性数据库中回顾性分析了术后出血患者的特征。分析了人口统计学数据、诊断、治疗（内科、剖腹手术、介入放射学）、与瘘管（胰瘘或胆瘘）的关系（胰瘘或胆瘘）、内外出血、出血时间（早期或晚期）、严重程度（中度/重度）和死亡率。
18 例患者（18/107；16.82%）在 PD 后出现出血。这 18 例患者中有 4 例（22.2%）出血发生在早期（<24 小时），其中 13 例（72%）为重度出血。与出血相关的死亡率为 11%（2/18），住院死亡率为 22.2%（4/18）。对 18 例患者中的 8 例（44.4%）进行了血管造影，其中 6 例（75%）有效；对 8 例患者（44.4%）进行了剖腹手术。第一次治疗后，这 18 例患者中有 5 例再次出血（27.8%）。出血与瘘管之间存在关联。
胰切除术后出血必须被视为一种具有相对高死亡率的并发症。应迅速确立诊断并给予治疗。胰瘘和/或胆瘘与术后出血的风险显著相关。介入放射学是一种很好的治疗选择。
