Risk Factors Analysis And Treatment Of Delayed Hemorrhage After Laparoscopic Pancreaticoduodenectomy

Research background:The pancreaticoduodenectomy(PD)is the preferred surgical method for treating pancreatic head tumors,periampullary tumors,and lower segment of bile duct tumors.With the development of laparoscopic surgical instruments and the accumulation and progress of surgical experience,LPD has matured and is being developed in more and more medical centers.Post-pancreatectomy hemorrhage(PPH)is one of the most severe complications after LPD.Literature has reported that the incidence of PPH after LPD is 3.0%-16.1%,and the associated mortality is as high as 11%-47%.PPH can be divided into early hemorrhage and delayed hemorrhage according to the time of occurrence.It has been noted in the literature that early hemorrhage may be associated with surgical causes or with an underlying perioperative coagulation disorder.For patients with early hemorrhage,through conservative treatment or secondary surgery,most patients can successfully stop the hemorrhage.However,the risk factors and mechanism of delayed hemorrhage are relatively complex,and the choice of treatment methods for patients with delayed hemorrhage has not been concluded yet,and the research on the related risk factors and prevention and treatment strategies has been a clinical issue of great concern at present.Research purpose:To analyze the risk factors of delayed hemorrhage after LPD,and to explore the prevention and treatment options of delayed hemorrhage,so as to reduce the incidence and mortality of delayed hemorrhage in perioperative period and improve the prognosis of LPD patients.Research methods:A total of 351 patients with LPD completed in the Department of Hepatobiliary Surgery and Center of Organ Transplantation of Shandong Provincial Hospital from March 2017 to June 2020 were selected.The preoperative,intraoperative,postoperative and pathological data of the patients were collected.According to the occurrence of delayed hemorrhage,the patients were segmented into hemorrhage group and non-hemorrhage group.All the potentially relevant variables during the perioperative period of patients in the two groups were statistically analyzed to analyze the independent risk factors for their occurrence.The hemorrhage characteristics,treatment plan and prognosis of patients in the bleeding group were collected to analyze the effects of different treatment plans in the treatment of delayed hemorrhage.Results:Among the 351 patients with LPD,216(61.5%)were males and 135(38.4%)were females.The patients ranged in age from 93 to 13,with an average of 59.15±12.10 years old.Delayed hemorrhage occurred in 40 cases(11.4%).Univariate analysis results showed that there were statistically significant differences between the two groups in age,long-term smoking history,long-term drinking history,delayed gastric empties,bile leakage,pancreatic fistula,gastrointestinal anastomotic fistula,abdominal infection and hyperglycemia(P<0.05).Multivariate analysis results of Logistic regression model showed that pancreatic fistula(grade B/C),bile leakage(grade B/C),gastrointestinal anastomotic fistula and abdominal infection were independent risk factors for delayed hemorrhage.Among the patients with hemorrhage group,there were 27 patients with celiac artery hemorrhage,of which 2 patients died of hypovolemic shock due to massive blood loss after active rescue after delayed hemorrhage.One patient underwent re-operation for hemostasis after delayed bleeding,but no re-hemorrhage occurred after hemostasis,and was cured.In 24 patients with delayed hemorrhage,interventional embolization was performed for hemostasis,20 patients were cured,and 4 patients died.Of the four patients who died,three died of multiple organ failure due to severe abdominal infection and one died of hemorrhagic shock due to massive hemorrhage again.There were 8 patients with abdominal wound hemorrhage,among which 7 patients received conservative treatment and 1 patient received reoperation.All the patients did not suffer from re-hemorrhage after treatment and were cured.There were 5 patients with simple gastrointestinal hemorrhage,of which 3 patients received conservative treatment and 2 patients received endoscopic electrocoagulation hemostasis.All the patients did not suffer from re-hemorrhage after treatment and were cured.Conclusion:(1)Pancreatic fistula(grade B/C),bile leakage(grade B/C),gastrointestinal anastomotic fistula and abdominal infection are independent risk factors for delayed hemorrhage after LPD.(2)Patients’ age,long-term smoking history,long-term drinking history,delayed gastric emptying(grade B/C)and postoperative hyperglycemia were associated with delayed hemorrhage bleeding,but not independent risk factors.(3)Select the appropriate treatment according to the time,location,degree and cause of bleeding in different patients;The management of abdominal infection should be strengthened in patients after interventional embolization.(4)Observe the patient’s condition closely;be alert to the occurrence of complications such as bile leakage,pancreatic fistula,gastrointestinal anastomotic fistula and abdominal infection;prompt treatment and intervention are the keys to prevent delayed hemorrhage.