摘要
目的探讨胰十二指肠切除术(PD)后上消化道出血(UGIH)的原因及防治。方法对本院1998年1月至2004年6月行PD术的195例患者的临床资料进行回顾性分析。结果18例患者发生UGIH,死亡4例。UGIH组术中低血压7例,行捆绑式胰肠吻合6例;而无UGIH组分别为26例和118例。术后UGIH组合并胰漏3例,合并肝功能不全6例,合并肾功能不全5例;而无UGIH组分别为6例、18例和12例。上述数据相比,两者差异有显著性(P<0.05)。PD术后UGIH早期(术后5d以内)发生4例,晚期(术后5d以上)发生14例。结论早期出血主要由胃肠吻合口或胰腺断端出血造成,晚期出血以吻合口溃疡或应激性溃疡为主。术中低血压,术后合并胰漏,肝肾功能不全是重要诱发因素。行捆绑式胰肠吻合能减少术后胰漏和出血的机会。早期出血以手术治疗为主,晚期出血以内科保守治疗为主。
Objective To investigate the pathogenesis, prevention and treatment of upper gastrointestinal hemorrhage （UGIH） after pancreatoduodenectomy （PD）. Methods From January 1998 to June 2004, 195 patients who had undergone PD at our hospital were retrospectively analyzed. Results UGIH occurred in 18 patients, and 4 patients died. Hypetention occurred in 7 patients, and binding-pancreatojejunostomy was carried out in 6 patients in the group who had undergone UGIH after PD; while those in the group who had no UGIH after PD were 26 （26/177 = 14.7% ） and 118 respectively. Three patients had pancreatic leak, Six patients was combined with hepatic dysfunction, and renal dysfunction was found in 5 patients in the UGIH group. While those in the group without UGIH were 6, 18 and 12, respectively. All these differences were statistically significant （P 〈 0.05）. Four patients bleeded （within 5 days after operation） and 14 patients bleeded after 5 days. Conclusion Hemorrhage within 5 days after operation is mostly caused by gastroenterostomy or pancreatic cut surface, and hemorrhage after 5 days occurs mainly because of anostomotic ulcer or stress ulcer. Hypetention, pancreatic leakage and hepatic or renal dysfunction are important factors in the pathogenesis of UGIH after PD. Binding-pancreatojejunostomy is a new technique to reduce leakage and hemorrhage after PD. Hemorrhage with 5 days after operation following PD should be treated by immediate ralaparotomy, while hemorrhage after 5 days should be controlled with internal medicine.
出处
《中华急诊医学杂志》
CAS
CSCD
2005年第11期942-944,共3页
Chinese Journal of Emergency Medicine
