CAJ | 학술논문

目的探讨胰腺切除术后迟发性大出血的原因、治疗方法和预后.方法回顾性分析浙江大学医学院附属第一医院2003年8月至2013年8月共1 554例胰腺切除术患者的临床资料.结果 16例患者手术后发生迟发性大出血,其中胰十二指肠切除术13例,胰体尾切除术3例;消化道出血6例,腹腔内出血10例;再手术11例,介入止血2例,内镜止血3例;3例死亡,3例家属放弃治疗后死亡,10例治愈.结论胰腺切除术后迟发性大出血病死率高,术后胰漏和应激性溃疡是最可能的危险因素,腹腔内动脉性出血是主要致死原因.及时再手术和术后腹腔持续灌注是有效的处理方法.
목적 탐토이선절제술후지발성대출혈적원인、치료방법화예후.방법 회고성분석절강대학의학원부속제일의원2003년8월지2013년8월공1 554례이선절제술환자적림상자료.결과 16례환자수술후발생지발성대출혈,기중이십이지장절제술13례,이체미절제술3례;소화도출혈6례,복강내출혈10례;재수술11례,개입지혈2례,내경지혈3례;3례사망,3례가속방기치료후사망,10례치유.결론 이선절제술후지발성대출혈병사솔고,술후이루화응격성궤양시최가능적위험인소,복강내동맥성출혈시주요치사원인.급시재수술화술후복강지속관주시유효적처리방법.
Objective To explore the cause,treatment and prognosis of delayed massive haemorrhage (DMH) after pancreatic resection.Method Clinical data of 1554 patients undergoing pancreatectomy in our hospital from Aug 2003 to Aug 2013 were retrospectively analyzed.Results 16 patients suffered from DMH,including 13 patients who had undergone pancreaticoduodenectomy,and 3 patients who had had resection of pancreatic body and tail.Gastrointestinal haemorrhage occurred in 6 patients,intra-abdominal haemorrhage occurred in 10 patients,respectively.Reoperations were performed in 11 patients,transcatheter arterial embolization (TAE) undertaken in 2 patients,and endoscopic treatment in 3 patients.10 patients recovered after treatment,6 patients (6/16) died.Conclusions The mortality of DMH after pancreatic surgery is high.Postoperative pancreatic leak and gastrointestinal stress ulcer are the most possible risk factors,intra-abdominal arterial haemorrhage is the main cause of death.