Analysis Of Risk Factors For Hemorrhage After Pancreaticoduodenectomy

Objective: Analyzing risk factors for post-pancreaticoduodenectomy hemorrhage(PPH)to explore reasons and therapy of hemorrhage,to improve surgeon therapy skill for PPH and forecast,to decrease mortality rate.Methods: Collecting clinical data of 504 patients from January 2008 to December 2015 who experienced pancreaticoduodenectomy in Affiliated Hospital of Qingdao University,related factors(sex,age,hypertension,diabetes,operation manners,preoperative hemoglobin level,intraoperative blood loss,operative time,preoperative PT,preoperative APTT,preoperative GGT,preoperative ALB,preoperative AST,preoperative ALT,POPF,biliary fistula,abdominal infection,incision infection and so on)were analyzed by univariate analysis,then by multivariate analysis,to explore the causes of bleeding and treatment strategies.Results: Of the 504 patients,332 males(65.9%),172 females(34.1%),maximum age 80 years,minimum age 18 years,average age was 59.1 years,hemorrhage group 49 cases,no hemorrhage group 455 cases.Early?PPH 18 cases(3.6%),1 case was death;of 9cases were treated by conservative way,8 cases discharged with a health condition,1 case was death;of 9 cases were reoperated,all discharged with a health condition,3 cases were not found clear blood points,6 cases could be found.late PPH 31 cases(6.2%),of 16 cases were treated by conservative way,4 cases were death,12 cases discharged with a health condition;of 14 cases were reoperated,1 case was death,13 cases discharged with a health condition,3 cases were not found clear blood points,11 cases could be found,because of failure of operation,of 4 cases were interventional therapy again,2 cases GDA aneurysmal hemorrhage,1 case arteriae pancreaticoduodenalis superior aneurysmal hemorrhage,1 case no recorded;of 1 case was interventional therapy,discharged with a health condition.The incidence of PPH was 9.7%(49/504),of the hemorrhage group 49 cases,abdominal hemorrhage 32 cases,digestive hemorrhage 9 cases,abdominal and digestive hemorrhage 8 cases,POPF 91 cases,no POPF 413 cases,the incidence of POPF was 18.0%(91/504).Death 7 cases,1 case was related with abdominal infection,5 cases were connected with late PPH,1 case was related with early PPH,mortality was 1.4%,hemorrhage-related mortality was 12.2%(6/49).Univariate analysis indicated that intraoperative blood loss(? 500 m L)was related to early PPH;intraoperative blood loss(? 500 m L),preoperative ALB(<35g/L),operative time(? 5h),preoperative high bilirubin level(? 256.5?mol/L),POPF,biliary fistula,abdominal infection,incision infection were associated with late PPH.Multivariate analysis showed that intraoperative blood loss was the independent risk factors for early PPH;preoperative ALB,operative time,abdominal infection were the independent risk factors for late PPH.Conclusion:(1)This research reveals that intraoperative blood loss(?500m L)was early PPH independent risk factor.(2)Early PPH was likely to associated with technical of operator and careful operation.(3)This research reveals that POPF was risk factor of late PPH,not the independent risk factor.(4)Preoperative ALB(<35g/L),operative time(?5h)was the independent risk of late PPH;abdominal infection was closely related with late PPH,late PPH occurrence rate of abdominal infection much higher than no-abdominal infection.