本文選題：胰十二指腸切除術　切入點：術后出血　出處：《福建醫(yī)科大學》2013年碩士論文

【摘要】：【目的】分析胰十二指腸切除術后腹腔和消化道出血的危險因素，探索出血原因及治療策略，，提高臨床醫(yī)生對該并發(fā)生癥的診療水平。 【方法】回顧性分析2009年5月至2013年5月在福建省立醫(yī)院行胰十二指腸切除術的152例胰十二指腸切除術患者的臨床資料，探索出血原因及治療策略。 【結果】152例患者中，男83例（54.6%），女男69例（45.4%），年齡25~73歲，平均年齡55.39歲，術后非出血組134例，出血組18例，發(fā)生率11.8％。其中上消化道出血7例（4.61%），腹腔出血7例（4.61%），上消化道合并腹腔出血4例（2.63%）。單因素分析結果表明：腹腔并發(fā)癥（胰瘺、膽瘺、腹腔感染及吻合口瘺等）、胰腸吻合方式為有統(tǒng)計學意義的相關因素（P0.05）。多因素分析結果表明：胰瘺、吻合口瘺以及吻合方式是術后出血的獨立危險因素，OR值分別為4.187；5.480；3.018。 【結論】胰瘺、吻合口瘺、胰腸吻合方式是胰十二指腸切除術后出血的獨立危險因素，先兆出血是預測術后出血發(fā)生的重要征象，血管造影檢查是早期診斷和提高救治成功率的有效方法，臨床醫(yī)生要重視假性動脈瘤破裂引起的術后出血。完善圍手術期處理，積極預防，及時發(fā)現(xiàn)并處理術后腹腔并發(fā)癥可減少術后出血的發(fā)生。
[Abstract]:[objective] to analyze the risk factors of abdominal and digestive tract hemorrhage after pancreaticoduodenectomy, to explore the causes and treatment strategies of bleeding, and to improve the diagnosis and treatment of the complication.[methods] the clinical data of 152 patients undergoing pancreatoduodenectomy in Fujian Provincial Hospital from May 2009 to May 2013 were retrospectively analyzed, and the causes of bleeding and the treatment strategies were explored.[results] among 152 patients, 83 cases were male and 69 cases were female. The average age was 55.39 years old. 134 cases were non-bleeding group, 18 cases were bleeding group, the incidence was 11.8%.There were 7 cases of upper gastrointestinal hemorrhage, 7 cases of abdominal hemorrhage, 7 cases of intraperitoneal hemorrhage and 4 cases of upper digestive tract complicated with abdominal hemorrhage.Univariate analysis showed that abdominal complications (pancreatic fistula, biliary fistula, celiac infection and anastomotic fistula, etc.) and pancreaticojejunostomy were statistically related factors (P 0.05).The results of multivariate analysis showed that the independent risk factors of postoperative hemorrhage were pancreatic fistula, anastomotic fistula and anastomosis mode. The OR values were 4.187 ~ 5.480 / 3.018, respectively.[conclusion] Pancreatic fistula, anastomotic fistula, pancreaticojejunostomy are independent risk factors for bleeding after pancreaticoduodenectomy. Threatened hemorrhage is an important sign in predicting postoperative hemorrhage.Angiography is an effective method for early diagnosis and improvement of success rate of treatment. Clinicians should pay attention to postoperative hemorrhage caused by rupture of pseudoaneurysm.Improving perioperative management, active prevention, and timely detection and treatment of postoperative abdominal complications can reduce postoperative bleeding.
【學位授予單位】：福建醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R657.5

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