胰十二指肠切除术后出血的预防及处理

Prevention and treatment of the hemorrhage after pancrea-ticoduodenectomy

  • 摘要: 胰十二指肠切除术(PD)是治疗壶腹部周围肿瘤的标准手术方式。出血是PD术后的凶险并发症,如何有效预防和处理一直是胰腺外科的难点,也是降低PD术后病死率的关键。本文汇集国内胰腺外科领域4位著名专家及其团队,结合各自中心的临床经验,从不同角度探讨PD术后出血的预防及处理策略。其中沈柏用教授结合其团队既往成功经验(采用全层紧贴式胰管对空肠黏膜吻合等)及前瞻性研究数据,从PD术后早期和晚期出血展开讨论;陈亚进教授根据PD术后出血不同原因,建议主要从解剖性切除、吻合重建、腹腔引流管放置与术后管理等方面防治;彭兵教授重点探讨腹腔镜PD术后出血,认为术中精细止血、精准吻合、合理放置腹腔引流管、优化围术期管理可降低术后胰瘘、胆瘘、腹腔感染发生率,从而降低腹腔镜PD术后出血发生率;谭广教授根据国际胰腺外科研究小组(ISGPS)对PD术后出血的分级,分别探讨A级(早期轻度)、B级(早期重度和晚期轻度)和C级(晚期重度)出血的处理策略。

     

    Abstract: Pancreaticoduodenectomy (PD) is a standard surgical method for periampullary cancer. The hemorrhage is a dangerous complication after PD, how to effectively prevent and treat hemorrhage is a difficult point of pancreatic surgery, and also a key for reducing postoperative mortality. Four famous experts and their teams in surgical field explored prevention and treatment of the hemorrhage after PD from different angles based on clinical experiences. Professor Shen Boyong has conducted a discussion on early and late hemorrhage after PD combined with previous successful experiences and prospective research data. Professor Chen Yajin suggested preventing hemorrhage in the aspects of anatomical resection, anastomosis and reconstruction, peritoneal drainage-tube placement and postoperative management based on different causes of hemorrhage. Professor Peng Bing paid attention to hemorrhage after laparoscopic PD, and supposed that intraoperative careful hemostasis, precise anastomosis, reasonable peritoneal drainage-tube placement and optimal perioperative management can reduce incidences of postoperative pancreatic fistula, biliary fistula and intra-abdominal infection, thereby lowering the incidence of hemorrhage. Professor Tan Guang respectively proposed processing strategies of hemorrhage for grading A (mild at early stage), B (severe at early stage and mild at late stage) and C (severe at late stage).

     

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