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一名82岁甲型血友病患者接受胰十二指肠切除术时的外科与内科联合管理

Surgical and Medical Co-Management in an 82-Year-Old Patient With Hemophilia a Undergoing Pancreaticoduodenectomy.

作者信息

Lu Wenning, Liu Chaoyang, He Jing, Cheng Rui

机构信息

Department of Comprehensive Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases Chinese PLA General Hospital Beijing China.

出版信息

Health Care Sci. 2025 May 25;4(3):229-233. doi: 10.1002/hcs2.70016. eCollection 2025 Jun.

DOI:10.1002/hcs2.70016
PMID:40568625
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12185365/
Abstract

We report the successful application of a surgical and medical co-management (SMC) strategy in an 82-year-old man with hemophilia A (HA) undergoing pancreaticoduodenectomy for pancreatic head carcinoma. No major complications or perioperative bleeding occurred. Optimal management of HA patients undergoing major surgery requires multidisciplinary coordination to avoid postoperative complications. The SMC team integrates internists (who assess chronic disease status, adjust medications, and determine best hemostatic therapies) and surgeons (who evaluate the surgical feasibility of procedures and rely on advanced surgical skills) to improve perioperative planning to minimize complications and promote recovery. This case illustrates the utility of a shift from passive and conservative treatment to active and preventive treatment and highlights the value of SMC in many complex clinical situations.

摘要

我们报告了一种手术与内科联合管理（SMC）策略在一名82岁患甲型血友病（HA）且因胰头癌接受胰十二指肠切除术的男性患者中的成功应用。未发生重大并发症或围手术期出血。对接受大手术的HA患者进行优化管理需要多学科协作，以避免术后并发症。SMC团队整合了内科医生（评估慢性病状况、调整药物并确定最佳止血疗法）和外科医生（评估手术的可行性并依靠先进的手术技能），以改进围手术期规划，将并发症降至最低并促进康复。该病例说明了从被动保守治疗向主动预防治疗转变的效用，并突出了SMC在许多复杂临床情况中的价值。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9811/12185365/1b5a7e3a5cfb/HCS2-4-229-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9811/12185365/35abaa4fd133/HCS2-4-229-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9811/12185365/63f3c87fa8fa/HCS2-4-229-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9811/12185365/e1506c053bb4/HCS2-4-229-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9811/12185365/1b5a7e3a5cfb/HCS2-4-229-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9811/12185365/35abaa4fd133/HCS2-4-229-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9811/12185365/63f3c87fa8fa/HCS2-4-229-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9811/12185365/e1506c053bb4/HCS2-4-229-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9811/12185365/1b5a7e3a5cfb/HCS2-4-229-g005.jpg

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本文引用的文献

1
Development and Validation of a Model for Postpancreatectomy Hemorrhage Risk.开发和验证一种用于胰腺切除术后出血风险的模型。
JAMA Netw Open. 2023 Dec 1;6(12):e2346113. doi: 10.1001/jamanetworkopen.2023.46113.
2
Surgical Risks and Survival Outcomes in Robotic Pancreaticoduodenectomy for the Aged Over 80: A Retrospective Cohort Study.80 岁以上老年人行机器人胰十二指肠切除术的手术风险和生存结局：一项回顾性队列研究。
Clin Interv Aging. 2023 Aug 24;18:1405-1414. doi: 10.2147/CIA.S411391. eCollection 2023.
3
Clinical conditions and risk factors for inhibitor-development in patients with haemophilia: A decade-long prospective cohort study in Japan, J-HIS2 (Japan Hemophilia Inhibitor Study 2).
日本血友病抑制剂研究 2 期（J-HIS2）：一项长达 10 年的前瞻性队列研究，评估血友病患者发生抑制剂的临床情况和危险因素。
Haemophilia. 2022 Sep;28(5):745-759. doi: 10.1111/hae.14602. Epub 2022 Jun 11.
4
Robotic versus open pancreaticoduodenectomy, comparing therapeutic indexes; a systematic review.机器人辅助与开放胰十二指肠切除术：治疗指标比较的系统评价
Int J Surg. 2022 May;101:106633. doi: 10.1016/j.ijsu.2022.106633. Epub 2022 Apr 26.
5
Complications After Pancreaticoduodenectomy.胰十二指肠切除术后并发症。
Surg Clin North Am. 2021 Oct;101(5):865-874. doi: 10.1016/j.suc.2021.06.011. Epub 2021 Jul 29.
6
The standardized technique and surgical video of robotic pancreaticoduodenectomy at the Chinese PLA General Hospital.中国人民解放军总医院机器人胰十二指肠切除术的标准化技术和手术视频。
Updates Surg. 2022 Feb;74(1):245-254. doi: 10.1007/s13304-021-01149-6. Epub 2021 Aug 8.
7
WFH Guidelines for the Management of Hemophilia, 3rd edition.《血友病管理的居家指南》第三版
Haemophilia. 2020 Aug;26 Suppl 6:1-158. doi: 10.1111/hae.14046. Epub 2020 Aug 3.
8
Evaluation of Internal Medicine Physician or Multidisciplinary Team Comanagement of Surgical Patients and Clinical Outcomes: A Systematic Review and Meta-analysis.内科学医师或多学科团队共同管理手术患者与临床结局的评估：系统评价与荟萃分析。
JAMA Netw Open. 2020 May 1;3(5):e204088. doi: 10.1001/jamanetworkopen.2020.4088.
9
Management of coagulation factor VIII (FVIII) inhibitors.FVIII 抑制剂的管理。
Thromb Res. 2019 Sep;181 Suppl 1:S60-S61. doi: 10.1016/S0049-3848(19)30369-X.
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Medical and surgical co-management - A strategy of improving the quality and outcomes of perioperative care.医疗与手术共同管理——提升围手术期护理质量和效果的策略。
Eur J Intern Med. 2019 Mar;61:44-47. doi: 10.1016/j.ejim.2018.10.017. Epub 2018 Nov 15.