中国实用外科杂志2025，Vol.45Issue(10)：1148-1154,7.DOI:10.19538/j.cjps.issn1005-2208.2025.10.15
远端胰腺切除术后迟发性出血临床特点及诊疗策略单中心研究
Clinical features and management strategies of delayed postoperative hemorrhage following distal pancreatectomy:a single-center study
摘要
Abstract
Objective To analyze the clinical characteristics,diagnostic approaches,and therapeutic outcomes of de-layed post-pancreatectomy hemorrhage(DPPH)following distal pancreatectomy(DP),in order to guide clinical decision-making.Methods A retrospective review based on the clinical data of 63 patients who developed DPPH after DP be-tween July 2018 and December 2023 at our center was conducted.According to the International Study Group for Pancre-atic Surgery(ISGPS)classification,29 cases were grade B(ISGPS-B group)and 34 were grade C(ISGPS-C group).Rel-evant risk factors,clinical features,and management strategies of DPPH were evaluated.Results Of these,22 under-went spleen-preserving DP(Kimura,n=19;War-shaw,n=3)and 41 underwent DP with splenectomy.Five patients(7.9％)died from DPPH-related causes.Sentinel bleeding was observed in 21 grade C cases(61.8％).The incidence rate of clinically rel-evant pancreatic fistula and intra-abdominal infec-tions in the ISGPS-C group was higher than that in the ISGPS-B group,and the difference was statisti-cally significant(94.1％vs.75.9％,P=0.039;55.9％vs.24.1％,P=0.020).The bleeding site was clearly localized in 34 cases(54.0％),with the gastroduodenal artery(n=7),splenic artery(n=6),and portal venous system(n=6)being the most common.The localization rates of contrast-enhanced CT and digital subtraction angiography(DSA)were 31.0％(13/42)and 60.9％(14/23),respectively(P=0.019).Hemosta-sis success rates were 80.0％(12/15)for endovascular embolization under DSA and 69.2％(18/26)for reoperation(P=0.716).In three cases of DPPH(one splenic artery stump hemorrhage and two celiac trunk hemorrhages),selective embo-lization of the celiac trunk was performed under DSA,with intraoperative angiography confirming adequate hepatic arte-rial supply,and all patients recovered uneventfully.Conclusion The gastroduodenal artery is a common bleeding site after DP.DSA provides higher localization accuracy and therapeutic efficacy,and should be considered the preferred di-agnostic and therapeutic strategy for DPPH following DP.关键词
远端胰腺切除术/术后迟发性出血/数字减影血管造影/再手术Key words
distal pancreatectomy/delayed postpancreatectomy hemorrhage/digital subtraction angiography/relapa-rotomy分类
医药卫生引用本文复制引用
林暐乔,钱涛,李慧亮,刘子葳,高顺良,白雪莉,马涛,梁廷波..远端胰腺切除术后迟发性出血临床特点及诊疗策略单中心研究[J].中国实用外科杂志,2025,45(10):1148-1154,7.基金项目
新疆生产建设兵团自然科学基金项目(No.2025DA063) （No.2025DA063）
新疆生产建设兵团重点领域科技攻关计划项目(No.2025AB049) （No.2025AB049）
浙江省高层次人才特殊支持计划资助项目(医疗卫生青年人才) Science and Technology Program of XPCC(No.2025DA063,No.2025AB049) （医疗卫生青年人才）
Zhejiang High-Level Talent Special Support Program(Young Medical Talents) （Young Medical Talents）
