Risk Factors And Treatment Strategies For Late Bleeding After Pancreaticoduodenectomy

Objective:To analyze the risk factors of advanced hemorrhage in pancreatoduodenectomy(PD)and discuss the methods of diagnosis and treatment.Methods: The clinical data of 449 patients undergoing pancreatoduodenectomy from January 2002 to December 2016 in the First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed.There were 265 males(59.0%)and 184females(41.0%).)Ages 19 to 81 years old,mean age 57.62 years old,334 cases Han nationality(74.4%),ethnic minorities 115 cases(25.6%),45 cases in the bleeding group,404 cases in the non-bleeding group,passing basic medical history data for 449 cases :Age,gender,presence of diabetes and hypertension,pathological diagnosis.Surgical factors: blood loss during surgery,blood transfusion in the operation,the time from the beginning to the end of the operation,and the intraoperative anastomosis.Postoperative complications included: pancreatic fistula,hemorrhage in the abdominal cavity and digestive tract,and intra-abdominal infection.The level of amylase in the peritoneal drainage fluid on the third day after operation,mortality,length of hospital stay,and presence or absence of aura bleeding.Treatment of patients with bleeding: Interventional treatment,failure after interventional treatment,re-opening surgery,only re-opening.conduct statistical analysis.Results: Statistical analysis showed that pathological diagnosis,abdominal infection,pancreatic leakage B/C grade,3 days after PD drainage fluid amylase level for pancreatic and duodenal risk factors,multivariate analysis showed pancreatic fistula B/C It was an independent risk factor for postoperative bleeding with an OR of 5.304.The statistical analysis of 26 cases of late PPH in three groups showed that patients with extraluminal hemorrhage more often choose radiological intervention intervention.There was no significant difference in patients with aura bleeding for the three intervention groups.Patients with POPF B/C were more likely to choose radiological interventions.There was no significant difference in hospitalization days and perioperative outcomes for the three interventions.Conclusion: The independent risk factor for hemorrhage afterpancreatoduodenectomy is pancreatic fistula B/C.A reasonable perioperative management of the risk factors for PPH can effectively reduce the incidence of post-PD hemorrhage(peritoneal and digestive tract)and death.rate.For the treatment of patients with advanced PPH with POPF B/C and extraluminal hemorrhage,interventional surgery is recommended.