Clinical Analysis Of Risk Factors For Postpancreatectomy Hemorrhage

Objective:The paper explores the risk factors of postpancreatectomy hemorrhage(PPH)and analyzes the causes and treatment strategies of PPH.Methods:The clinical data of 511 patients who underwent pancreaticoduodenectomy from January 2015 to December 2017 in the Department of Hepatobiliary Surgery of Hunan Provincial People's Hospital were collected.According to the inclusion and exclusion criteria,499 patients were selected for retrospective analysis.The collected clinical data includes:1.Preoperative data: the age and gender of patients,whether the patients suffering from hypertension or diabetes,albumin level,total bilirubin level,prothrombin time,whether the patients accept preoperative jaundice reduction;Intraoperative data: operation time,blood loss,blood transfusion,the differences between Open Pancreatodudenectomy and Laparoscopic Pancreatodudenectomy,whether there are vascular remodeling or multi-visceral resection;3.Postoperative data: whether the patients were complicated by pancreatic fistula,biliary fistula,intra-abdominal infection or delayed gastric emptying.By statistical methods,the relevant factors of PPH,which may beinfluenced by the above 18 indicators,were analyzed in terms of the two-factor single factor of bleeding and non-bleeding.Statistical factors(risk factors)were selected from each single factor factor.Multivariate analysis was performed to determine independent risk factors for PPH and thus explore the treatment strategies.All statistical data obtained were done in SPSS 22.0 with P < 0.05 and the difference was considered statistically significant.Results:Of 499 patients,49 developed PPH,with an incidence of 9.8%.Among them,8 patients had early bleeding and 41 patients had delayed bleeding.Two patients died of PPH in the hospital during the perioperative period,and the mortality rate was 4.1%.In univariate analysis,preoperative hypertension,preoperative hyperbilirubinemia(171 ?mol/l),laparoscopic pancreaticoduodenectomy,postoperative pancreatic fistula and abdominal infection were the risk factors for PPH.Multivariate Logistic analysis showed that preoperative hyperbilirubinemia(171 ?mol/l),postoperative pancreatic fistula and abdominal infection were the independent risk factors for PPH.Conlusion:This study shows that preoperative hypertension,preoperative hyperbilirubinemia(171 ? mol/l),laparoscopic pancreaticoduodenectomy,postoperative pancreatic fistula and abdominal infection were the risk factors for PPH.Preoperative hyperbilirubinemia(171?mol/l),postoperative pancreatic fistula and abdominal infection were independent risk factors for PPH.Early hemorrhage is closely related to the operative technique.Delayed blood flow is associated with coagulation dysfunction and postoperative complications of pancreatic fistula and intra-abdominal infection in patients with hyperbilirubinemia(171 ?mol/l).