Risk Factors and Treatments of Hemorrhage after Pancreaticoduodenectomy:a Report of 168 Cases

WANG Ming-feng; ZHAO Bao-cheng

doi:10.3969/j.issn.1002-3429.2017.01.022

Abstract：Objective To investigate risk factors and treatments of hemorrhage after pancreaticoduodenectomy in or-der to improve operative safety. Methods Clinical data of 168 patients undergoing pancreaticoduodenectomy was retrospec-tively analyzed. Results All patients were used Child method for reconstruction of digestive tract,putting drainage of silicone tube within pancreatic duct and putting abdominal cavity drainage tube near the digestive tract anastomosis,and the operative time was 4. 5-8. 0 h,and intraoperative volume of blood loss was 300-3000 ml with 600 ml of average intraoperative blood transfusion. Among 18 patients(10. 7﹪)with postoperative hemorrhage,10 patients had peritoneal cavity bleeding( pro-phase in 7 cases and advanced stage in 3 cases),8 patients had gastrointestinal bleeding( prophase in 5 cases and advanced stage in 3 cases). Reasons for prophase hemorrhage were intraoperative loss of ligation line,disturbances of blood coagula-tion,pancreatic stump bleeding and anastomotic stoma bleeding;main reasons of advanced stage hemorrhage were the pancre-aticojejunostomy anastomotic leakage,gastrointestinal leakage and abdominal infection. Conclusion It is essential in preven-tion and treatment of hemorrhage after pancreaticoduodenectomy by improving nutritional status of patients and reasonable con-trol jaundice before operation,operating reliably and paying more attention to sentinel bleed during operation,and finding in time and treating accurately after operation .