Abstract:
Objective To explore the risk factors and treatment of delayed massive hemorrhage after pancreaticoduodenectomy (PD).
Methods From January 2010 to January 2019, clinical data of 222 patients who underwent PD in Huai’an First Hospital of Nanjing Medical University were retrospective analyzed. The cause, time, treatment and outcome of bleeding were summarized. Univariate and Logistic regression analysis were used to analyze the risk factors of delayed bleeding after PD.
Results There were 17 cases (7.7%) of delayed massive hemorrhage after PD, including 13 cases of abdominal hemorrhage and 4 cases of gastrointestinal hemorrhage. The overall mortality was 35.3% (6/17), the bleeding time was 12 (5-23) days after operation. Preoperative total bilirubin≥171 μmol/L (OR=1.011, 95% CI: 1.000-1.020, P=0.043), postoperative abdominal infection (OR=4.012, 95% CI: 1.302-12.357, P=0.016), and postoperative pancreatic fistula above grade B (P<0.05) were independent risk factors affecting the occurrence of delayed massive hemorrhage after PD.
Conclusions Reducing bilirubin levels before surgery, actively treating pancreatic fistula after surgery, and controlling abdominal infections are the keys to preventing its occurrence. Specific treatment and individual intervention strategies should be based on the actual situation of patients.
Key words:
Pancreaticoduodenectomy,
Postoperative hemorrhage,
Risk factors,
Delayed
Bing Zhou, Yong Sun, Ling Liu, Dianhua Gu, Weidong Yuan, Hewei Zhao, Peng Sun. Risk factors and treatment strategy of delayed massive hemorrhage after pancreaticoduodenectomy[J]. Chinese Archives of General Surgery(Electronic Edition), 2020, 14(03): 207-210.