Clinical Analysis And Prevention Of Hemorrhage After Laparoscopic Pancreatoduodenectomy

Objective:By analyzing the risk factors of hemorrhage after laparoscopic pancreatoduodenectomy(LPD)and discussing the prevention and treatment strategies of postoperative hemorrhage,we can improve the prognosis of patients after LPD and reduce the perioperative mortality.Methods:The clinical data of 400 patients with laparoscopic pancreatoduodenectomy from 2015 to 2019 were analyzed retrospectively.According to the occurrence of postoperative bleeding,they were divided into bleeding group and non bleeding group.The data of the two groups before,during and after operation were statistically analyzed to determine the independent risk factors of bleeding after LPD.Results:Among the 400 patients with LPD,217 were male(55.3%),183 were female(44.7%),the ratio of male to female was about 1.2:1.0,the age range was 9-79 years old,the average age was 57 years old;there were 33 patients with postoperative bleeding(abdominal cavity and digestive tract),19 patients with postoperative intraperitoneal bleeding,12 patients with gastrointestinal bleeding,1 patient with both intraperitoneal bleeding and gastrointestinal bleeding,1 patient with unspecified bleeding site,the incidence of postoperative bleeding was 8.25%.The results of single factor analysis showed that there were statistically significant related factors(P < 0.05).The results of two logistic regression analysis showed that ALB < 35 g / L before operation,bleeding volume ? 500 ml during operation,pancreatic fistula and abdominal infection were independent risk factors for postoperative bleeding,or values were 3.208,3.698,8.780 and 5.066 respectively(see Table 2).In addition,the incidence of bleeding was 5.8% in patients without postoperative pancreatic fistula,27.6% in grade B pancreatic fistula(8/29)and 66.7% in grade C pancreatic fistula(4/6).The difference was statistically significant(P < 0.05).Therefore,the severity of pancreatic fistula(grade B/C)was closely related to postoperative bleeding.Conclusions:(1)This study showed that ALB < 35 g / L,intraoperative bleeding ? 500 ml,pancreatic fistula and abdominal infection were independent risk factors of postoperative bleeding in patients with LPD.(2)The occurrence of postoperative hemorrhage is closely related to the severity of pancreatic fistula.(3)This study showed that preoperative hypertension,operation time ? 300 min,and intraoperative vascular reconstruction were the risk factors of postoperative bleeding in LPD patients,but not independent risk factors.(4)It is the key link to prevent postoperative hemorrhage of LPD to improve nutritional status,correct hypoproteinemia,stop bleeding thoroughly,reduce bleeding volume,strengthen perioperative management,cut off the process of "pancreatic fistula celiac infection bleeding" trilogy,and reduce the probability of postoperative pancreatic fistula and infection.