Risk factors and treatment for hemorrhage after pancreaticoduodenectomy
Shubo Pan, Hongchuan Zhao, Xiaoping Geng, Shengxue Xie, Jiangming Chen, Hui Hou, Kun Xie, Shengyun Wang, Fubao Liu
Published 2016-05-25
Cite as Chin J Gen Surg, 2016, 31(5): 378-381. DOI: 10.3760/cma.j.issn.1007-631X.2016.05.005
Abstract
ObjectiveTo explore the risk factors, managements and outcomes of postoperative hemorrhage (PPH) of pancreaticoduodenectomy (PD).
MethodsThe clinical data of 260 PD patients from July 2005 to January 2015 was retrospectively analyzed. Multivariate Logistic regression analysis was used to determine the main independent risk factors for PPH.
ResultsThe incidence of PPH was 11.7% (24/206). Among these 24 patients: 3 patients were grade A of PPH, 11 were grade B of PPH and 10 were grade C of PPH. Hemostasis was attempted by endotherapy in 2 patients and successful in 1. Angioembolization was performed in 10 patients and in 7 the causes were identified and bleeding was successfully controlled in 5 (5/7, 71.4%). Relaparotomy in 10 patients controlled hemorrhage in 7 (70%). Sentinel bleeding occurred in 43.8% of PPH mortalities (7/16). Multivariate Logistic regression analysis showed pancreatic fistula and intraabdominal infection as independent risk factor of post PD hemorrhage.
ConclusionsPancreatic fistula and abdominal infections are closely correlated with PPH. Endoscopy therapy is an approach for early hemorrhages, angiography interventions or surgical treatment are required for delayed hemorrhages.
Key words:
Pancreaticoduodenectomy; Postoperative hemorrhage; Treatment
Contributor Information
Shubo Pan
Depentment of General Surgery, the Second Hospital of Anhui Medical University, Hefei 230601, China
Hongchuan Zhao
Xiaoping Geng
Shengxue Xie
Jiangming Chen
Hui Hou
Kun Xie
Shengyun Wang
Fubao Liu