Diagnosis and treatment of delayed postoperative hemorrhage after pancreaticoduodenectomy

Objective To summarize the clinical experience in the diagnosis and treatment of delayed postoperative hemorrhage after pancreaticoduodenectomy.Methods The clinical data of 246 patients who received pancreaticoduodenectomy at the First Affiliated Hospital of Xinjiang Medical University from January 2002 to February 2013 were retrospectively analyzed.Patients with pancreatic head carcinoma and ampullary malignancies received standard pancreaticoduodenectomy or combined organ resection,and patients with benign and duodenal tumor received pylorus-preserving pancreaticoduodenectomy.Pancreatic anastomosis was done using pancreaticogastrostomy or pancreaticojejunostomy.Delayed hemorrhage was defined as bleeding at the operation site after 5 or more postoperative days.Patients were divided into the gastrointestinal hemorrhage group and the abdominal hemorrhage group according to the bleeding site,and the treatment methods included conservative treatment or surgical treatment (including interventional therapy and laparotomy).The Measurement data were expressed as mean ± standard deviation,and the enumeration data were compared using the Fisher exact probability.Results There were 224 patients received pancreaticoduodenectomy,10 received pylorus-preserving pancreaticoduodenectomy,9 received pancreatieoduodenectomy + portal vein resection or replacement,1 received pancreaticoduodenectomy + superior mesenteric vein replacement,1 received pancreaticoduodenectomy + resection of quadrate lobe of liver and 1 received pancreaticoduodenectomy + resection of left semihepatectomy.There were 127 patients received improved end-to-side pancreaticojejunostomy,53 received pancreaticogastrostomy,39 received end-to-end pancreaticojejunostomy and 27 received mucosa-to-mucosa pancreaticojejunostomy.Fifteen patients died perioperatively,with the mortality rate of 6.10％ (15/246).Twenty-nine patients were complicated with delayed hemorrhage with the rate of 11.79％ (29/246),including 14 with gastrointestinal hemorrhage and 15 with abdominal hemorrhage.There were 9 patients with mild hemorrhage (5 with gastrointestinal hemorrhage and 4 with abdominal hemorrhage) and 20 with severe hemorrhage (9 with gastrointestinal hemorrhage and 11 with abdominal hemorrhage).Seventeen patients had sentinel bleeding,including 5 with abdominal hemorrhage and 12 with gastrointestinal hemorrhage.Twenty-nine patients received conservative treatment,and the success rates of conservative treatment were 8/14 in the gastrointestinal hemorrhage group,which was significantly higher than 2/15 of the abdominal hemorrhage group (P ＜ 0.05).Patients who failed in conservative treatment received surgical treatment.Of the 20 patients with severe hemorrhage,19 were cured by surgical treatment and I was cured by conservative treatment.Nine patients with mild hemorrhage received conservative treatment,8 were cured and 1 died of pulmonary infection.Of the 29 patients with delayed postoperative hemorrhage,10 died with the mortality rate of 34.5％ (10/29).The morality rate of the gastrointestinal hemorrhage group was 2/14,which was lower than 8/15 of the abdominal hemorrhage group,with no significant difference between the 2 groups (P ＞ 0.05).Conclusions Most of the delayed postoperative hemorrhage after pancreaticoduodenectomy severe and combined with sentinel bleeding.Gastrointestinal hemorrhage can be cured through conservative treatment,but abdominal hemorrhage need surgical treatment. Key words: Pancreaticoduodenectomy ;  Postoperative hemorrhage ;  Diagnosis ;  Treatment