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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 causes and prevention of upper gastrointestinal bleeding (UGIH) after pancreatoduodenectomy (PD). Methods The clinical data of 195 patients who underwent PD in our hospital from January 1998 to June 2004 were analyzed retrospectively. Results 18 cases of UGIH occurred, 4 patients died. In the UGIH group, there were 7 cases of intraoperative hypotension and 6 cases of bundled pancreaticojejunostomy. There were 26 cases and 118 cases without UGIH group. Postoperative UGIH combined with pancreatic leakage in 3 cases, with hepatic insufficiency in 6 cases, with renal insufficiency in 5 cases; without UGIH were 6 cases, 18 cases and 12 cases. Compared with the above data, the difference was significant (P <0.05). In the early postoperative period of PDI, 4 cases occurred in the early stage of postoperative UGIH (within 5 days after operation), and 14 cases occurred in the late stage (more than 5 days after operation). Conclusions Early hemorrhage is mainly caused by gastrointestinal anastomosis or hemorrhage of the pancreas, and late hemorrhage is mainly anastomotic ulcer or stress ulcer. Intraoperative hypotension, postoperative pancreatic leakage, liver and kidney dysfunction is an important predisposing factor. Bundled pancreaticojejunostomy can reduce postoperative pancreatic leakage and bleeding opportunities. Early surgical treatment of bleeding-based, advanced conservative treatment of bleeding-based medicine.