胰十二指肠切除术后出血的临床分析

发布时间：2018-04-04 03:49

本文选题：胰十二指肠切除术　切入点：术后出血　出处：《福建医科大学》2013年硕士论文

【摘要】：【目的】分析胰十二指肠切除术后腹腔和消化道出血的危险因素，探索出血原因及治疗策略，，提高临床医生对该并发生症的诊疗水平。【方法】回顾性分析2009年5月至2013年5月在福建省立医院行胰十二指肠切除术的152例胰十二指肠切除术患者的临床资料，探索出血原因及治疗策略。【结果】152例患者中，男83例（54.6%），女男69例（45.4%），年龄25~73岁，平均年龄55.39岁，术后非出血组134例，出血组18例，发生率11.8％。其中上消化道出血7例（4.61%），腹腔出血7例（4.61%），上消化道合并腹腔出血4例（2.63%）。单因素分析结果表明：腹腔并发症（胰瘘、胆瘘、腹腔感染及吻合口瘘等）、胰肠吻合方式为有统计学意义的相关因素（P0.05）。多因素分析结果表明：胰瘘、吻合口瘘以及吻合方式是术后出血的独立危险因素，OR值分别为4.187；5.480；3.018。【结论】胰瘘、吻合口瘘、胰肠吻合方式是胰十二指肠切除术后出血的独立危险因素，先兆出血是预测术后出血发生的重要征象，血管造影检查是早期诊断和提高救治成功率的有效方法，临床医生要重视假性动脉瘤破裂引起的术后出血。完善围手术期处理，积极预防，及时发现并处理术后腹腔并发症可减少术后出血的发生。
[Abstract]:[objective] to analyze the risk factors of abdominal and digestive tract hemorrhage after pancreaticoduodenectomy, to explore the causes and treatment strategies of bleeding, and to improve the diagnosis and treatment of the complication.[methods] the clinical data of 152 patients undergoing pancreatoduodenectomy in Fujian Provincial Hospital from May 2009 to May 2013 were retrospectively analyzed, and the causes of bleeding and the treatment strategies were explored.[results] among 152 patients, 83 cases were male and 69 cases were female. The average age was 55.39 years old. 134 cases were non-bleeding group, 18 cases were bleeding group, the incidence was 11.8%.There were 7 cases of upper gastrointestinal hemorrhage, 7 cases of abdominal hemorrhage, 7 cases of intraperitoneal hemorrhage and 4 cases of upper digestive tract complicated with abdominal hemorrhage.Univariate analysis showed that abdominal complications (pancreatic fistula, biliary fistula, celiac infection and anastomotic fistula, etc.) and pancreaticojejunostomy were statistically related factors (P 0.05).The results of multivariate analysis showed that the independent risk factors of postoperative hemorrhage were pancreatic fistula, anastomotic fistula and anastomosis mode. The OR values were 4.187 ~ 5.480 / 3.018, respectively.[conclusion] Pancreatic fistula, anastomotic fistula, pancreaticojejunostomy are independent risk factors for bleeding after pancreaticoduodenectomy. Threatened hemorrhage is an important sign in predicting postoperative hemorrhage.Angiography is an effective method for early diagnosis and improvement of success rate of treatment. Clinicians should pay attention to postoperative hemorrhage caused by rupture of pseudoaneurysm.Improving perioperative management, active prevention, and timely detection and treatment of postoperative abdominal complications can reduce postoperative bleeding.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R657.5

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