中国普外基础与临床杂志

中国普外基础与临床杂志

重症急性胰腺炎术后腹腔出血的危险因素分析及诊治经验

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目的 总结重症急性胰腺炎术后腹腔出血的危险因素及其诊治经验。 方法 回顾性分析 2011–2015 年期间于四川大学华西医院行胰腺坏死清除术的 347 例重症胰腺炎患者的临床资料。 结果 347 例患者中,术后发生腹腔出血 38 例,其中出血 2 次 5 例,仅发生 1 次出血 33 例。出血部位:脾静脉 7 例次,脾动脉2 例次,胰腺及胰周血管 8 例次,结肠系膜血管 6 例次,其他部位 12 例次,不明确 7 例次。止血方法:缝扎 20 例次,压迫止血 18 例次,介入治疗 2 例次,缝扎+压迫 4 例次,保守治疗 1 例次。38 例腹腔出血患者中,死亡 19 例。腹腔出血组与无腹腔出血组患者的性别、入院时急性生理与慢性健康评分(APACHE Ⅱ评分)、入院时改良 Marshall 评分、发病距手术时间、手术方式及死亡情况比较差异均有统计学意义(P<0.05)。与无腹腔出血组比较,腹腔出血组患者中男性较多、入院时 APACHE Ⅱ评分和入院时改良 Marshall 评分较高,发病距手术时间较长,手术方式以开腹手术为主,死亡率较高。进一步进行多因素分析,结果显示,男性患者的腹腔出血风险高于女性(OR=3.980,P=0.004),且随着入院时改良 Marshall 评分增加,腹腔出血风险增加(OR=1.487,P<0.001)。 结论 尤其对男性及多器官功能衰竭的 SAP 患者,需警惕 SAP 术后腹腔出血的发生。

Objective To summarize the risk factors, diagnosis, and treatment experience of intra-abdominal bleeding following surgeries for severe acute pancreatitis. Methods A retrospective review was conducted of 347 patients underwent necrosectomy for severe acute pancreatitis between January 2011 and December 2015 at West China Hospital of Sichuan University. Results Of the 347 patients, thirty-eight patients had intra-abdominal bleeding after surgeries, including 5 patients who had twice bleeding. The bleeding positions including splenic vein (n=7), splenic artery (n=2), pancreatic and peripancreatic vessels (n=8), colonic mesangial vessels (n=6), other vessels (n=12), and extensive osmotic bleeding in abdominal cavity (n=7). Hemostatic modes: suture (n=20), compression hemostasis (n=18), transcatheteranerial embolism (n=2), suture and compression hemostasis (n=4), and conservative treatment (n=1). There were 19 dead patients of 38 bleeding patients. There were statistically significant differences between the hemorrhage group and the non-hemorrhage group on gender, acute physiology and chronic health evaluation (APACHEⅡ) scores and modified Marshall scores at admission, interval onset to surgery, surgical approaches, and morbidity (P<0.05). Compared with the non-hemorrhage group, there were more males, higher APACHE Ⅱ scores and modified Marshall scores, longer interval onset to surgery, and higher mortality in the hemorrhage group. Multivariable logistic regression analysis showed that male patients had higher risk of intra-abdominal bleeding (OR=3.980, P=0.004), as the grow of APACHEⅡ scores, the risk of intra-abdominal bleeding increased (OR=1.487, P<0.001). Conclusions We should pay more attention on the male SAP patients as well as patients with multiple organ dysfunction.

关键词: 重症急性胰腺炎; 腹腔出血; 影响因素

Key words: severe acute pancreatitis; intra-abdominal bleeding; risk factor

引用本文: 张凌, 卢山, 陆慧敏, 胡伟明. 重症急性胰腺炎术后腹腔出血的危险因素分析及诊治经验. 中国普外基础与临床杂志, 2018, 25(5): 565-571. doi: 10.7507/1007-9424.201712026 复制

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