CAJ | 학술논문

目的探讨胰十二指肠切除术(PD)术后消化道出血的原因及治疗.方法对我院1996年1月至2011年12月213例PD患者和2例由外院转入的PD术后消化道出血患者的临床资料进行回顾性分析.结果 213例PD共出现术后消化道出血18例,发生率8.5％ (18/213).18例患者中4例死亡,病死率22.2％ (4/18).在20例消化道出血病例(我院的18例和外院转入的2例)中,应激性溃疡为最常见的出血原因(11例,55％).轻度出血8例,均通过内科药物治疗止血；重度出血12例,其中7例接受了再次手术.单因素分析显示手术时间≥420 min(x2 =3.976,P=0.046)和术中出血量≥1200 ml(x2=6.753,P=0.009)与术后应激性溃疡出血有关,多因素分析显示只有术中出血量为独立危险因素(OR=5.677,P=0.035).结论消化道出血是PD术后的常见并发症之一.术中熟练操作,减少出血量,有助于减少术后应激性溃疡出血的发生.在内科治疗效果不佳时,应及时再手术止血,根据出血的原因和部位采取适当的手术方式.
목적 탐토이십이지장절제술(PD)술후소화도출혈적원인급치료.방법 대아원1996년1월지2011년12월213례PD환자화2례유외원전입적PD술후소화도출혈환자적림상자료진행회고성분석.결과 213례PD공출현술후소화도출혈18례,발생솔8.5％ (18/213).18례환자중4례사망,병사솔22.2％ (4/18).재20례소화도출혈병례(아원적18례화외원전입적2례)중,응격성궤양위최상견적출혈원인(11례,55％).경도출혈8례,균통과내과약물치료지혈；중도출혈12례,기중7례접수료재차수술.단인소분석현시수술시간≥420 min(x2 =3.976,P=0.046)화술중출혈량≥1200 ml(x2=6.753,P=0.009)여술후응격성궤양출혈유관,다인소분석현시지유술중출혈량위독립위험인소(OR=5.677,P=0.035).결론 소화도출혈시PD술후적상견병발증지일.술중숙련조작,감소출혈량,유조우감소술후응격성궤양출혈적발생.재내과치료효과불가시,응급시재수술지혈,근거출혈적원인화부위채취괄당적수술방식.
Objective To analyze the cause and treatment of the postoperative gastrointestinal hemorrhage after pancreaticoduodenectomy(PD).Methods Clinical data of 213 patients who underwent PD in our hospital from January 1996 to December 2011 and 2 patients who suffered from gastrointestinal hemorrhage after PD transferred to our hospital from other hospitals were retrospectively analyzed.Results The incidence of postoperative gastrointestinal hemorrhage was 8.5％ (18/213),the mortality rate of which was 22.2％ (4/18).Among the twenty patients with postoperative gastrointestinal hemorrhage (including the 2 patients transferred from other hospitals),stress ulcer was the most common reason of gastrointestinal hemorrhage (11/20,55 ％).There were 8 patients suffering from mild hemorrhage who were treated by medications.Seven of 12 patients who suffered from severe hemorrhage underwent reoperation.Univariate analysis showed that duration of operation above 420 min (x2 =3.976,P =0.046) and volume of intraoperative blood loss above 1200 ml (x2 =6.753,P =0.009) were significantly associated with postoperative stress ulcer bleeding.Multivariate logistic regression analysis showed that intraoperative blood loss was the only independent factor associated with postoperative stress ulcer bleeding (OR =5.677,P =0.035).Conclusion Gastrointestinal hemorrhage is one of the common complications after PD.The incidence of stress ulcer bleeding could be reduced by skillful operation and decreasing intraoperative blood loss.Operation should be used properly according to the cause and location of bleeding if hemorrhage could not be stopped by medications.