| Objective: To retrospective analyze the incidence, perioperative mortality and risk factors of late postpancreatectomy hemorrhage, and to value the curative effect of laparotomy and interventional radiology for late PPH.Methods: We undertook an electronic search of Cochrane library?Embase?Pubmed databases from 1900 to December of 2015.The articles were selected and evaluated according to the inclusion and exclusion criteria, related information of which was statistically analyzed with Rev Man 5.3 software. A random-effect meta-analysis for success rate?recurrent bleeding?mortality of laparotomy vs. interventional radiology after delayed PPH was performed.The Mantel–Haenszel method was used to combine the odds ratio.Results: 18 articles were enrolled in the study, which have 8323 pancreatectomy patients, in which have 334 late PPH patients with a occurrence rate of 4%(334/8323). 11 articles of the references recorded sentinel bleeding and the sentinel bleeding ratio was 51.6%(95/184) in late PPH. 16 articles reported bleeding types, including extraluminal hemorrhage(bleeding in the abdominal cavity) with a incidence rate of 47.5%(124/261), intraluminal hemorrhage(bleeding in the digestive tract) with a incidence rate of 44%(115/261), the incidence rate of both intraluminal and extraluminal hemorrhage was 8.5%(22/261). There are 13 articles which have reported pancreatic leakage of late PPH patients, whose incidence rate was 54%(135/250).The total mortality of late PPH patients was 25%(86/334). Pancreatic leakage and peritoneal abscess are independent risk factors for late hemorrhage after pancreatectomy. Among 334 cases of patients with late PPH, 24.6%(82/334) had laparotomy, 48.2%(161/334) had interventional radiology treatment, and the others were treated by endoscopic or other conservative treatment. The results show that there were no statistically significant differences between interventional radiology group and laparotomy group in the complete hemostasis(P=0.81); No significant difference were found between the radiology group and the intervention radiology group(P=0.10) for the recurrent hemorrhage rate after the first time in the treatment.The mortality of patients in laparotomy group was significantly higher than that of intervention group, with a statistically significant difference(P=0.001).Conclusions:1. The prevention and timely treatment of complications after pancreatectomy can minimize the occurrence of late PPH, especially for pancreatic fistula and intra-abdominal abscess.2. To have early angiography could avoid progression to massive bleeding by enhance the vigilance of sentinel bleeding.3. The mortality of late PPH patients with interventional radiology was significantly lower than that with laparotomy by the meta-analysis.Purpose: To discuss the therapeutic strategy of late postpancreatectomy hemorrhage(PPH)Methods: By retrospective analyze the clinical data of 29 cases of late PPH patients in 1690 patients who have had pancreatectomy in Department of pancreatic surgery, Union Hospital, Huazhong University of Science and Technology from January 2005 to December 2015.And then, propose optimized therapeutic strategy.Result Our department had operated 1690 pancreatectomies during the last 10 years,there are 29 patients who developed late PPH after surgery. The specific surgical methods in late PPH patients are: 17 patients received pancreaticoduodenectomy, 7 patients received segmental pancreatectomy, and 5 patients received duodenum-preserving pancreatic head resection(DPPHR). 15 cases of patients had abdominal bleeding,10 cases had gastrointestinal bleeding,4 cases had both abdominal and gastrointestinal bleeding,the average time point of hemorrhage is 12 days after surgery. During those late PPH patients, 2 of them got treated by conservative treatment successfully, 20 of them got their first treatment by interventional radiology. Among those 20 patients who got interventional therapy, 9 of them with successful hemostasis(45%,9/20), 3 of them had rebleeding(33.33%,3/9), 6 patients eventually died(30%,6/20). 7 of the 29 late PPH patients received laparotomy, and 6 of them with successful hemostasis(85.70%,6/7), 1 patient had rebleeding(16.67%,1/6), and 1 patient died(14.20%,1/7). Among the 29 patients, 13 of them had sentinel bleeding, the occurrence rate is 44.83%(13/29); 15 of them had pancreatic fistula(51.72%,15/29); and 16 of them had abdominal infection(55.17%,16/29). 7 of the 29 late PPH patients died, the death rate is 24.13%(7/29).Conclusion Mortality is high in patients with late PPH, while pancreatic leakage and abdominal infection are the main risk factors, so actively management and precaution on pancreatic fistula and abdominal infection are very important to avoid PPH. Bleeding sentinel is an important sign to predict massive bleeding. When sentinel bleeding happens, patients should get interventional radiology immediately. And patients with massive bleeding who has no indication to get intervention should get exploratory laparotomy actively. |
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