Wellner U F, Kulemann B, Lapshyn H, Hoeppner J, Sick O, Makowiec F, Bausch D, Hopt Ulrich Theodor, Keck T
Clinic for General and Visceral Surgery, University Medical Center Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
J Gastrointest Surg. 2014 Mar;18(3):464-75. doi: 10.1007/s11605-013-2437-5. Epub 2014 Jan 22.
Postpancreatectomy hemorrhage is a rare but often severe complication after pancreatic resection. The aim of this retrospective study was to define incidence and risk factors of postpancreatectomy hemorrhage and to evaluate treatment options and outcome.
Clinical data was extracted from a prospectively maintained database. Descriptive statistics, univariate and multivariate risk factor analysis by binary logistic regression were performed with SPSS software at a significance level of p = 0.05.
N = 1,082 patients with pancreatic resections between 1994 and 2012 were included. Interventional angiography was successful in about half of extraluminal bleeding. A total of 78 patients (7.2 %) had postpancreatectomy hemorrhage (PPH), and 29 (2.7 %) were grade C PPH. Multivariate modeling disclosed a learning effect, age, BMI, male sex, intraoperative transfusion, portal venous and multivisceral resection, pancreatic fistula and preoperative biliary drainage as independent predictors of severe postpancreatectomy hemorrhage. High-risk histopathology, age, transfusion, pancreatic fistula, postpancreatectomy hemorrhage and pancreatojejunostomy in pancreatoduodenectomies were independent predictors of mortality.
Our study identifies clinically relevant risk factors for postpancreatectomy hemorrhage and mortality. Interventional treatment of extraluminal hemorrhage is successful in about half of the cases and if unsuccessful constitutes a valuable adjunct to operative hemostasis. Based on our observations, we propose a treatment scheme for PPH. Risk factor analysis suggests appropriate patient selection especially for extended resections and pancreatogastrostomy for reconstruction in pancreatoduodenectomy.
胰腺切除术后出血是胰腺切除术后一种罕见但通常较为严重的并发症。本回顾性研究的目的是确定胰腺切除术后出血的发生率和危险因素，并评估治疗方案及预后。
临床数据取自一个前瞻性维护的数据库。使用SPSS软件进行描述性统计、单因素和多因素危险因素分析，二元逻辑回归分析的显著性水平为p = 0.05。
纳入了1994年至2012年间1082例行胰腺切除术的患者。介入性血管造影在大约一半的腔外出血病例中取得成功。共有78例患者（7.2%）发生胰腺切除术后出血（PPH），其中29例（2.7%）为C级PPH。多因素模型显示学习效应、年龄、体重指数、男性、术中输血、门静脉和多脏器切除、胰瘘以及术前胆道引流是严重胰腺切除术后出血的独立预测因素。在胰十二指肠切除术中，高危组织病理学、年龄、输血、胰瘘、胰腺切除术后出血和胰肠吻合术是死亡的独立预测因素。
我们的研究确定了胰腺切除术后出血和死亡的临床相关危险因素。腔外出血的介入治疗在大约一半的病例中取得成功，若不成功则是手术止血的重要辅助手段。基于我们的观察结果，我们提出了一种PPH的治疗方案。危险因素分析提示应进行适当的患者选择，尤其是对于扩大切除术以及胰十二指肠切除术中用于重建的胰胃吻合术。
