Clinical characteristics and management strategies of late bleeding after laparoscopic pancreaticoduodenectomy
10.3760/cma.j.cn113884-20230420-00125
- VernacularTitle:腹腔镜胰十二指肠切除术后晚期出血的临床特征及处理策略
- Author:
Qiusheng LI
1
;
Zejia ZHANG
;
Zhongqiang XING
;
Wei HE
;
Weihong ZHAO
;
Pengxiang LIU
;
Ruibin LIU
;
Jiansheng ZHANG
;
Wenyan LU
;
Jianhua LIU
Author Information
1. 河北医科大学第二医院肝胆外科，石家庄 050000
- Keywords:
Laparoscopy;
Erosive factors;
Pancreaticoduodenectomy;
Postoperative hemorrhage
- From:
Chinese Journal of Hepatobiliary Surgery
2023;29(8):589-593
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To study the clinical characteristics and management strategies of late bleeding after laparoscopic pancreaticoduodenectomy (LPD).Methods:The clinical data of 58 patients with post-pancreaticoduodenectomy hemorrhage (PPH) admitted to the Department of Hepatobiliary Surgery of the Second Hospital of Hebei Medical University from March 2018 to March 2022 were retrospectively analyzed, including 42 males and 16 females, aged (61.88±11.02) years old. According to the occurrence of intra-abdominal erosion factors (e.g., pancreatic fistula, biliary fistula, gastrointestinal anastomotic fistula, intra-abdominal abscess), patients were divided into the erosion group ( n=42) and non-erosion group ( n=16). All patients underwent standard lymphadenectomy. Clinical data including the PPH time-point, occurrence of rebleeding, and treatment outcomes were accessed. The management strategies of PPH in the two groups of patients were analyzed. Results:The PPH time-point in the erosion group and non-erosion patients was 8.00 (5.00, 19.25) d and 21.50 (12.75, 26.75) d, respectively ( P=0.001). PPH can occurred within one month after surgery in both erosion and non-erosion groups. In the erosion group, 31 cases (73.81%, 31/42) were treated by re-operation, two (4.76%, 2/42) by interventional radiology and nine (21.43%, 9/42) with conservative protocol, respectively. In the non-erosion group, five cases (31.25%, 5/16) were treated by re-operation, seven (43.75%, 7/16) by interventional radiology and four (25.00%, 4/16) with conservative protocol, respectively. The incidence of re-bleeding is higher in the erosion group [47.6% (20/42) vs 12.5% (2/16), P<0.05]. Clinical manifestations, sites and severity of bleeding, and treatment outcomes were also different in the erosion and non-erosion groups (all P<0.05). Conclusions:The occurrence of intra-abdominal erosion factors can affect the clinical characteristics and treatment strategy of late bleeding after laparoscopic pancreaticoduodenectomy. Surgery remains the treatment of choice for post-pancreaticoduodenectomy hemorrhage either as an urgent or last resort.
