胰腺手术后并发症的防治.ppt

The prevention and management of postoperative complications in pancreatic surgery The Department of Hepato-biliary-pancreatic Surgery in Chang Hai Hospital Introduction:classification Hemorrhage Pancreatic fistula Intraabdominal abscess Delayed gastric emptying Wound infection Diabetes Pancreatic exocrine insufficiency Introduction:definition Incidence: America To trace the evolution of pancreaticoduodenectomy from the decade of the 1960s through the first decade of the new Millenium, through the experience of one surgeon doing 1000 consecutive operations Operative time : 8.8 hours in the 1970s and 5.5 hours during the 2000s. Postoperative length of stay : 17 days in the 1980s to 9 days in the 2000s. Mortality: 1% Morbidity:20% to 30% Incidence: Germany Current practice patterns in pancreatic surgery: results of a multi-institutional analysis of seven large surgical departments in Germany with 1454 pancreatic head resections, 1999 to 2004 (German Advanced Surgical Treatment study group) Department of Surgery, University of Freiburg, Germany Mortality was between 1.1% and 4.8% Morbidity was between 24% and 46% Pancreatic leakage was between 9% and 20% Incidence: China Japan Morbidity: 12.3% to 45% Hemorrhage Early and delayed hemorrhage Incidence: 0.5% to 6.8% Hemorrhage Early hemorrhage Hemorrhage within the first 24 hours after surgery is generally caused by a technical failure and needs immediate adequate hemostasis through a relaparotomy Hemorrhage Delayed hemorrhage Sepsis: 50% to 74% Anastomotic leakage: 23% to 65% Sentinel bleeding: 78% to 100% Relaparotomy: 14% to 30% Hemorrhage Delayed hemorrhage Septic DH Gastroduodenal A. Hepatic A. Mesentery A. Pancreatic parenchyma A. PJHJGEEE Arterial DH Pancreatic parenchyma A. Splenic hepatic A. Suture-line DH GEEEPJ Hemorrhage ultrasonography and computed tomography play a supplementary role in detecting intraabdominal inflammation Hemorrhage