| PART ?Objectives: In order to improve the positive detection rate of PPH patients,this thesis discusses the diagnostic value of digital subtraction angiography(DSA)for patients with different types of p postpancreatectomy hemorrhage(PPH)and tries to find the risk factors that affect the positivity of angiography.Methods:The first part retrospectively selects 71 patients with clear clinical bleeding signs after different types of pancreatic surgery in our hospital from September 10,2015 to December 28,2018.According to the results of angiography,the results were divided into two groups: positive group(n = 41)and negative group(n = 30).The main observation endpoint was the clinical bleeding signs(decreased hemoglobin,clear hemorrhage by imaging,sentinel bleeding,hemorrhagic shock)after pancreatic surgery.The direct or indirect signs of bleeding were confirmed by DSA angiography.Multi-factor and single-factor binary logistic analysis is performed to determine the risk factors affecting the positive rate of DSA diagnosis of PPH patients.Results:In the first part,there were differences in the length of surgery(41.4% VS25.0% P<0.05)and the location of bleeding(angiographically positive and negative)was 19.5% vs.56.7% intraluminally and 63.4% vs.40.0% extraluminally.(P<0.05)in the angiography positive and the negative group.There was a statistical difference between the two groups of patients.In addition,hemorrhagic shock has a statistically significant effect on the positive rate of DSA angiography in patients with PPH(P<0.05).The rate of positive DSA angiography in PPH patients with hemorrhagic shock before angiography is lower,therefore,hemorrhagic shock affects the positive rate of DSA angiography in PPH patients,which makes it an independent risk factor.Conclusions:DSA is an effective diagnostic method for postoperative hemorrhage of the pancreas while hemorrhagic shock reduces the positive rate of DSA diagnosis in patients with PPH.PART ?Objectives:Regarding PPH patients receiving endovascular interventional therapy,the effects of different types of bleeding patients and different interventions on the hemostatic success rate of patients are also discussed,so as to provide a theoretical basis for PPH patients to choose appropriate clinical decisions.Methods:The second part reviews 48 of the 71 patients who underwent endovascular interventional therapy.The success rate of interventional hemostasis was counted and divided into two groups based on whether the hemostasis was successful: the successful hemostasis group(n = 38)and the failed hemostasis group(n = 10).The main observation endpoint is the technical success and clinical success of the patients after embolization.To explore the factors affecting the success rate of hemostasis,the variations in bleeding patterns and interventions between the two groups were compared.Results:Part ? The success rate of interventional hemostasis technology was 97.9%(47/48),and the clinical success rate of hemostasis was 79.2%(38/48).The success rate of clinical hemostasis obtained by endovascular interventional therapy alone was 85.4%(41/48,38 cases of clinical hemostasis were successfully intervened for the first time while 3 cases of hemorrhage were successfully intervened after rebleeding).There was no statistical difference in the clinical success rates of conservative treatment,surgical treatment,and endovascular interventional therapy in patients with rebleeding(P>0.05).In the hemostatic success group and the hemostatic failure group,the average age(54.39 ± 15.41 vs 64.2 ± 6.41),the number of overweight patients(23.7%(12/38)vs 70.0%(7/10)),and preoperative reduction of jaundice(10.5%(10/38)vs 40.0%(4/10)),postoperative anastomotic fistula(5.3%(2/38)vs 40.0%(4/10)),mean bleeding time(20.95± 14.57 vs 27.00 ± 34.95)And 1-year mortality(5.3%(2/38)vs 50.0%(5/10))was statistically different(P<0.05).The incidence of related complications after intervention was 0.0%(0/48).The responsible blood vessels were related to the surgical method of pancreas.The death in the hemostatic success group was mostly related to the primary disease and surgical complications(2/2)while deaths were mostly associated with bleeding(4/5)in the hemostatic failure group.Conclusions:Endovascular interventional therapy is an effective and safe method for postpancreatectomy hemorrhag,for the vast majority of PPH patients have achieved successful clinical hemostasis through simple intervention.The incidence of related complications after intervention is low.The average age,the number of overweight patients,and preoperative reduction of jaundice,postoperative anastomotic fistula,mean bleeding time affect the rate of success of interventional therapy.The death in the hemostatic success group was lower and mostly related to the primary disease and surgical complications. |
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