Management of clinically relevant postpancreatectomy hemorrhage (PPH) over two decades – A comparative study of 1 450 consecutive patients undergoing pancreatic resection

医学 内脏的 血管造影 吻合 病死率 外科 入射(几何) 栓塞 内窥镜检查 队列 放射科 内科学 流行病学 血流 光学 物理
作者
Steffen Wolk,Robert Grützmann,Nuh N. Rahbari,Ralf Hoffmann,Verena Plodeck,Jürgen Weitz,Thilo Welsch,Marius Distler
出处
期刊:Pancreatology [Elsevier]
卷期号:17 (6): 943-950 被引量:29
标识
DOI:10.1016/j.pan.2017.10.006
摘要

PPH is the main cause of mortality (up to 50%) after pancreatic resection. Due to differences in time of onset, localization and clinical impairment, there is no consistent management algorithm. Between 1994 and 2014 the occurrence of PPH in 115 out of 1 450 patients from a prospectively collected database was analyzed. The cohort was divided into two time periods: 1994–2009 and 2010–2014. The differences between the two groups were analyzed. The overall incidence of PPH was 7.9%. The main causes of hemorrhage were the pancreatic anastomosis (31.1%) and the splanchnic arteries (23.5%). In the first period, there were more anastomotic hemorrhages (40.0% vs. 20.4%, p = 0.02), while in the second period more hemorrhages from the splanchnic arteries occurred (12.3% vs. 37%, p = 0.002). Bleeding control was achieved by relaparotomy (45.7%), noninterventionally (22.8%), endoscopically (19.7%) and angiographically (13.4%). In the second period, the relevance of interventional angiography significantly increased (24.6% vs. 4.3%, p = 0.001), whereas endoscopy lost importance (7% vs. 30%, p = 0.001). The in-hospital case fatality rate after PPH was 27.4%, with higher case fatality rate following extraluminal hemorrhage (23.9% vs. 3.4%, p < 0.001). A shift in the management of PPH could be seen over the two periods. Interventional angiography has gained more importance in the treatment of severe extraluminal hemorrhage of the splanchnic arteries. Adequate treatment of PPH is crucial to improve the outcome.
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