Abstract: Objective:To investigate the risk factors of postoperative hemorrhage after pancreatoduodenectomy (PD).
Methods:The retrospective casecontrol study was adopted. The clinical data of 857 patients with pancreatic diseases who were admitted to the First Affiliated Hospital of Hunan Normal University from January 2007 to December 2014 were collected. All the 857 patients underwent PD and digestive tract reconstruction using the Child method. The number of patients with postoperative hemorrhage, classification, bleeding sites, source and time of bleeding and method and effect of treatment after PD were observed. The correlations among the gender, age, concomitant diseases(diabetes and hypertension), malignancy degree of tumor, the preoperative levels of serum alanine transaminase (ALT), total bilirubin (TBil), albumin (Alb) and prothrombin time (PT), international normalized ratio (INR), operation time, volume of intraoperative blood loss, method of pancreatic and jejunal anastomosis and postoperative hemorrhage after PD were analyzed. The followup of outpatient examination and telephone interview was performed to observe postoperative recovery of patients for 2 months till February 2015. Univariate analysis and multivariate analysis were done using the chisquare test and Logistic regression model, respectively.
Results:Of 72 patients with postoperative hemorrhage,grade A, B and C hemorrhage were detected in 3, 41 and 28 patients, respectively, and 41, 29 and 2 patients had respectively enteral hemorrhage, parenteral hemorrhage and enteral and parenteral hemorrhage. After PD, 38 patients had hemorrhage located at the gastrointestinal tract, 9 at the common hepatic artery, proper hepatic artery and gastroduodenal artery (5 due to pseudoaneurysm), 5 at the pancreatic section, 3 at the jejunal mesenteric vessels, 2 at the middle colic arterial branches, 1 at the superior mesenteric artery, 1 at the superior mesenteric vein and 13 at the ambiguous bleeding sites. The early and late stage hemorrhages (within postoperative hour 24 and after postoperative hour 24) were detected in 20 and 52 patients, respectively. Of 44 patients with grade A and B of hemorrhages, 17 underwent conservative treatment, 16 underwent reoperation, 8 underwent hemostatic therapy under gastroscopy, 3 underwent interventional treatment. All the 44 patients had good hemostasis effect. Of 28 patients with grade C of hemorrhage, interventional treatment, reoperation, hemostatic therapy under gastroscopy, conservative treatment, interventional treatment+reoperation and gastroscopy+interventional treatment were applied to 10, 7, 4, 3, 3 and 1 patients, respectively. Ten of 28 patients died and 18 had successful hemostasis. The gender and preoperative levels of ALT and TBil were related factors affecting postoperative hemorrhage after PD in the univariate analysis (χ²=4.516, 7.585, 7.209, P<0.05). Male, preoperative ALT≥172 U/L and preoperative TBil≥159 μmol/L were the independent risk factors affecting postoperative hemorrhage after PD in the multivariate analysis (HR=2.033, 1.860, 1.872, 95% confidence interval: 1.237-3.341, 1.135-3.047, 1.060-3.307, P<0.05）.Fifty of 62 patients were followed up for a median time of 2 months with a followup rate of 80.6%(50/62), and no rehemorrhage was occurred.
Conclusion Male, preoperative ALT≥172 U/L and preoperative TBil≥159 μmol/L are the independent risk factors affecting postoperative hemorrhage after PD.