Risk factors of postoperative hemorrhage after pancreatoduodenectomy

• DOI: 10.3760/cma.j.issn.1673-9752.2016.02.012
• Publication Date: 2016-02-20
• Authors: Xiao Luo; Meifu Chen; Lufeng Liang; Guoguang Li; Jianming Liu
• Keywords: Prothrombin time; Univariate analysis; Concomitant; Gastrointestinal bleeding

Objective To investigate the risk factors of postoperative hemorrhage after pancreatoduodenectomy (PD).

Methods The retrospective case-control study was adopted. The clinical data 857 patients with pancreatic diseases who were admitted to First Affiliated Hospital Hunan Normal University from January 2007 December 2014 collected. All underwent PD and digestive tract reconstruction using Child method. number hemorrhage, classification, bleeding sites, source time method effect treatment observed. correlations among gender, age, concomitant diseases(diabetes hypertension), malignancy degree tumor, preoperative levels serum alanine transaminase (ALT), total bilirubin (TBil), albumin (Alb) prothrombin (PT), international normalized ratio (INR), operation time, volume intraoperative blood loss, jejunal anastomosis analyzed. follow-up outpatient examination telephone interview performed observe recovery for 2 months till February 2015. Univariate analysis multivariate done chi-square test Logistic regression model, respectively.

Results Of 72 grade A, B C detected in 3, 41 28 patients, respectively, 41, 29 had respectively enteral parenteral hemorrhage. After PD, 38 located at gastrointestinal tract, 9 common hepatic artery, proper artery gastroduodenal (5 due pseudoaneurysm), 5 section, 3 mesenteric vessels, middle colic arterial branches, 1 superior vein 13 ambiguous sites. early late stage hemorrhages (within hour 24 24) 20 52 respectively. Of 44 A hemorrhages, 17 conservative treatment, 16 reoperation, 8 hemostatic therapy under gastroscopy, interventional treatment. good hemostasis effect. treatment+ reoperation gastroscopy+ applied 10, 7, 4, Ten died 18 successful hemostasis. gender ALT TBil related affecting univariate (χ2=4.516, 7.585, 7.209, P<0.05). Male, ALT≥172 U/L TBil≥159 μmol/L independent (HR=2.033, 1.860, 1.872, 95% confidence interval: 1.237-3.341, 1.135-3.047, 1.060-3.307, Fifty 62 followed up a median rate 80.6%(50/62), no rehemorrhage occurred.

Conclusion Male, are PD.

Key words: Pancreatic diseases; Pancreatoduodenectomy; Postoperative hemorrhage; Risk