Results of surgical treatment on post-pancreaticoduodenectomy hemorrhage / 中华肝胆外科杂志

ABSTRACT

Objective:To study the results of surgical treatment on post-pancreaticoduodenectomy hemorrhage (PPH).Methods:The clinical data of 47 patients who developed PPH after pancreaticduodenectomy treated with surgery at the First Affiliated Hospital of University of Science and Technology of China from January 2012 to December 2020 were retrospectively analyzed. The operative indications, bleeding site, intraoperative treatment and prognosis were analyzed.Results:There were 33 males and 14 females, aged 42 to 81 (mean 60) years. Early hemorrhage occurred in 17 patients and delayed hemorrhage in 30 patients. A total of 35 patients developed intraperitoneal hemorrhage, 7 gastrointestinal hemorrhage and 5 intraperitoneal combined with gastrointestinal hemorrhage. The indications for surgery were hemodynamic instability ( n=31) and other treatment failure ( n=10). In 17 patients (36.2%), hemorrhage was associated with blood vessels. In 14 patients (29.8%), hemorrhage was associated with anastomotic stoma, while in 6 patients (12.8%) with gastrointestinal hemorrhage, the bleeding was non-anastomotic related. Early hemorrhage was mainly vascular related, and the surgical treatment mainly consisted of suture hemostasis at the bleeding site combined with abdominal irrigation and drainage. Delayed hemorrhage was most commonly anastomotic associated, and its management should consider avoiding anastomotic fistula formation after treatment. The operation time of early hemorrhage was significantly shorter than that of delayed hemorrhage [(136.0±37.5) min vs. (191.1±73.8)min, t=-3.289, P<0.05]. The incidence of re-hemorrhage was 23.4% (11 patients) and 9 patients died with a mortality rate of 19.1%. The re-hemorrhage and mortality rates of early-stage bleeding were significantly lower than those of delayed bleeding [5.9%(1/17) vs. 33.3%(10/30), 0 vs. 30.0%(9/30), P<0.05]. Conclusions:Surgical treatment of early hemorrhage had better results than that of delayed bleeding. Patients with anastomotic related hemorrhage were at high-risks of postoperative death after surgery. Recurrent bleeding was the main cause of death.