胰腺术后出血的临床预防及处理策略
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摘要
出血是胰腺外科术后最严重的并发症,也是导致患者临床死亡的主要原因.随着手术方式的进步及微创技术的快速发展,外科医师有了更多的应对术后出血的处理手段,但如何针对不同出血原因、部位采取合理有效的治疗措施,长期以来困扰着每位胰腺外科医生.本文就胰腺切除术后出血部位、原因,预防措施及治疗方案做一综述,以期对临床具有一定指导意义.
Hemorrhage is the most serious complication after pancreatic surgery and is also the main cause of clinical death. With the progress of surgical methods and the rapid development of minimally invasive techniques, surgeons have more technical means to deal with postoperative hemorrhage. It is still inconsistent in terms of taking effective therapeutic measures according to different causes of bleeding. And this has long plagued every pancreatic surgeon. This article reviews the location, causes, preventive measures, and treatment of hemorrhage after pancreatectomy, in order to provide some guidance to clinicians.
Hemorrhage is the most serious complication after pancreatic surgery and is also the main cause of clinical death. With the progress of surgical methods and the rapid development of minimally invasive techniques, surgeons have more technical means to deal with postoperative hemorrhage. It is still inconsistent in terms of taking effective therapeutic measures according to different causes of bleeding. And this has long plagued every pancreatic surgeon. This article reviews the location, causes, preventive measures, and treatment of hemorrhage after pancreatectomy, in order to provide some guidance to clinicians.
引文
1 Sakai M,Nakao A,Kaneko T,Takeda S,Inoue S,Yagi Y,Okochi O,Ota T,Ito S.Transhepatic portal venous angioplasty with stenting for bleeding jejunal varices.Hepatogastroenterology2005;52:749-752[PMID:15966197]
2 Tien YW,Lee PH,Yang CY,Ho MC,Chiu YF.Risk factors of massive bleeding related to pancreatic leak after pancreaticoduodenectomy.J Am Coll Surg 2005;201:554-559[PMID:16183493 DOI:10.1016/j.jamcollsurg.2005.05.007]
3 Povoski SP.Novel applications of Endo GIA linear staplers during pancreaticoduodenectomy and total pancreatectomy.Am J Surg 2001;182:77-80[PMID:11532422 DOI:10.1016/S0002-9610(01)00650-X]
4刘兴贵,孙诚谊,胡韵.一次性直线型切割吻合器在胰十二指肠切除术中的应用.贵阳医学院学报2004;29:461-462[DOI:10.19367/j.cnki.1000-2707.2004.05.035]
5彭淑牖,刘颖斌,李海军.外科器械应用新进展--胰十二指肠切除术后出血的防治及PMOD的应用.中国现代手术学杂志2004;8:262-264[DOI:10.16260/j.cnki.1009-2188.2004.05.002]
6倪克梁,彭淑牖,崔健.胰十二指肠切除术并发症的预防.肝胆胰外科杂志2002;14:239-240
7 Balachandran P,Sikora SS,Raghavendra Rao RV,Kumar A,Saxena R,Kapoor VK.Haemorrhagic complications of pancreaticoduodenectomy.ANZ J Surg 2004;74:945-950[PMID:15550080 DOI:10.1111/j.1445-1433.2004.03212.x]
8 Srivastava S,Sikora SS,Kumar A,Saxena R,Kapoor VK.Outcome following pancreaticoduodenectomy in patients undergoing preoperative biliary drainage.Dig Surg 2001;18:381-387[PMID:11721113 DOI:10.1159/000050178]
9 Yoshida T,Ninomiya S,Matsumata T.Management of bleeding pseudoaneurysms after pancreatoduodenectomy.Arch Surg 2003;138:458[PMID:12686535 DOI:10.1001/archsurg.138.4.458-a]
10 Choi SH,Moon HJ,Heo JS,Joh JW,Kim YI.Delayed hemorrhage after pancreaticoduodenectomy.J Am Coll Surg2004;199:186-191[PMID:15275871 DOI:10.1016/j.jamcollsur g.2004.04.005]
11 Yoon YS,Kim SW,Her KH,Park YC,Ahn YJ,Jang JY,Park SJ,Suh KS,Han JK,Lee KU,Park YH.Management of postoperative hemorrhage after pancreatoduodenectomy.Hepatogastroenterology 2003;50:2208-2212[PMID:14696500]
12 Sewnath ME,Birjmohun RS,Rauws EA,Huibregtse K,Obertop H,Gouma DJ.The effect of preoperative biliary drainage on postoperative complications after pancreaticoduodenectomy.J Am Coll Surg 2001;192:726-734[PMID:11400966]
13 Hodul P,Creech S,Pickleman J,Aranha GV.The effect of preoperative biliary stenting on postoperative complications after pancreaticoduodenectomy.Am J Surg 2003;186:420-425[PMID:14599600 DOI:10.1016/j.amjsurg.2003.07.005]
14张和,孙备,白雪巍,陈华,李军,谭宏涛,姜洪池.胰腺中段切除术29例临床分析.中国普外基础与临床杂志2013;20:1045-1048
15 Oida T,Mimatsu K,Kawasaki A,Kanou H,Kuboi Y,Kida K,Amano S.Transduodenal pancreatic juice drainage for preventing pancreatic fistula formation after distal pancreatectomy.Hepatogastroenterology 2011;58:177-182[PMID:21510310]
16李乐,孙备,姜洪池.保留脾脏胰腺远端切除术专家共识.中国实用外科杂志2014;34:6-9
17 Balzano G,Zerbi A,Di Carlo V.Spleen-preserving distal pancreatectomy with excision of splenic artery and vein:a cautionary note.World J Surg 2007;31:1530;author reply 1531[PMID:17487525 DOI:10.1007/s00268-007-9055-x]
18 Jain G,Chakravartty S,Patel AG.Spleen-preserving distal pancreatectomy with and without splenic vessel ligation:a systematic review.HPB(Oxford)2013;15:403-410[PMID:23458666 DOI:10.1111/hpb.12003]
19 Rieder B,Krampulz D,Adolf J,Pfeiffer A.Endoscopic pancreatic sphincterotomy and stenting for preoperative prophylaxis of pancreatic fistula after distal pancreatectomy.Gastrointest Endosc 2010;72:536-542[PMID:20598301 DOI:10.1016/j.gie.2010.04.011]
20申宏,王功锦,亢朝胜,王振波,粟劲松,蔡吉亮,邓祖龙.胰腺损伤的外科治疗体会.肝胆胰外科杂志2009;17:295-296
21 Debi U,Kaur R,Prasad KK,Sinha SK,Sinha A,Singh K.Pancreatic trauma:a concise review.World J Gastroenterol2013;19:9003-9011[PMID:24379625 DOI:10.3748/wjg.v19.i47.9003]
22 Antonacci N,Di Saverio S,Ciaroni V,Biscardi A,Giugni A,Cancellieri F,Coniglio C,Cavallo P,Giorgini E,Baldoni F,Gordini G,Tugnoli G.Prognosis and treatment of pancreaticoduodenal traumatic injuries:which factors are predictors of outcome?J Hepatobiliary Pancreat Sci 2011;18:195-201[PMID:20936305 DOI:10.1007/s00534-010-0329-6]
23冀亮,孙备,程春东,白雪巍,王刚,孔瑞,陈华,姜洪池.创伤递升式分阶段治疗重症急性胰腺炎局部并发症的临床经验总结.中华外科杂志2016;54:839-843
24姜脉涛,宋增福,姜洪池,孙备,白雪巍.胰腺术后出血预防及诊治研究(附518例胰腺手术分析).中国实用外科杂志2015;35:316-321
25董齐,董明.预防和治疗手术后应激性溃疡的现代策略.中国实用外科杂志2006;26:65-67
26 Felder LR,Barkin JS.A comparison of omeprazole and placebo for bleeding peptic ulcer.Gastrointest Endosc 1998;47:428-429[PMID:9609447 DOI:10.1016/S0016-5107(98)90003-1]
27 Lau JY,Sung JJ,Lee KK,Yung MY,Wong SK,Wu JC,Chan FK,Ng EK,You JH,Lee CW,Chan AC,Chung SC.Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers.N Engl JMed 2000;343:310-316[PMID:10922420 DOI:10.1056/NEJM200008033430501]
28 Tsirlis T,Vasiliades G,Koliopanos A,Kopanakis N,Katseli A,Tsipras H,Margaris H.Pancreatic leak related hemorrhage following pancreaticoduodenectomy.A case series.JOP 2009;10:492-495
29 Zografos GN,Kopanakis N,Vasiliades G,Perysinakis H,Vaidakis D,Avlonitis S,Margaris I,Tsipras I.Pancreatic fistula following distal pancreatectomy:How to prevent.Hell J Surg 2012;84:335-339[DOI:10.1007/s13126-012-0055-4]
30 Kuroki T,Tajima Y,Kanematsu T.Surgical management for the prevention of pancreatic fistula following distal pancreatectomy.J Hepato-Biliary-Pan 2005;12:283-285[DOI:10.1007/s00534-005-0990-3]
31 Wellner UF,Kulemann B,Lapshyn H,Hoeppner J,Sick O,Makowiec F,Bausch D,Hopt UT,Keck T.Postpancreatectomy hemorrhage--incidence,treatment,and risk factors in over1,000 pancreatic resections.J Gastrointest Surg 2014;18:464-475[PMID:24448997 DOI:10.1007/s11605-013-2437-5]
32 Yekebas EF,Wolfram L,Cataldegirmen G,Habermann CR,Bogoevski D,Koenig AM,Kaifi J,Schurr PG,Bubenheim M,Nolte-Ernsting C,Adam G,Izbicki JR.Postpancreatectomy hemorrhage:diagnosis and treatment:an analysis in 1669consecutive pancreatic resections.Ann Surg 2007;246:269-280[PMID:17667506 DOI:10.1097/01.sla.0000262953.77735.db]
33 Imperiale TF,Birgisson S.Somatostatin or octreotide compared with H2 antagonists and placebo in the management of acute nonvariceal upper gastrointestinal hemorrhage:a meta-analysis.Ann Intern Med 1997;127:1062-1071[PMID:9412308 DOI:10.7326/0003-4819-127-12-199712150-00002]
34 Clarke DL,McKune A,Thomson SR.Octreotide lowers gastric mucosal blood flow in normal and portal hypertensive stomachs.Surg Endosc 2003;17:1570-1572[PMID:12874677DOI:10.1007/s00464-002-9274-z]
35 Poon RT,Lo SH,Fong D,Fan ST,Wong J.Preven-tion of pancreatic anastomotic leakage after pancreaticoduodenectomy.Am J Surg 2002;183:42-52[PMID:11869701 DOI:10.1016/S0002-9610(01)00829-7]
36 Shan YS,Sy ED,Lin PW.Role of somatostatin in the prevention of pancreatic stump-related morbidity following elective pancreaticoduodenectomy in high-risk patients and elimination of surgeon-related factors:prospective,randomized,controlled trial.World J Surg 2003;27:709-714[PMID:12732998 DOI:10.1007/s00268-003-6693-5]
37史佩东,薛利军,尹浩然.胰腺损伤的诊断与手术治疗探讨(附34例报告).肝胆胰外科杂志2008;20:397-399
38 Otah E,Cushin BJ,Rozenblit GN,Neff R,Otah KE,Cooperman AM.Visceral artery pseudoaneurysms following pancreatoduodenectomy.Arch Surg 2002;137:55-59[PMID:11772216 DOI:10.1001/archsurg.137.1.55]
39 Khalsa BS,Imagawa DK,Chen JI,Dermirjian AN,Yim DB,Findeiss LK.Evolution in the Treatment of Delayed Postpancreatectomy Hemorrhage:Surgery to Interventional Radiology.Pancreas 2015;44:953-958[PMID:25906453 DOI:10.1097/MPA.0000000000000347]
40 Ota S,Suzuki S,Mitsuoka H,Unno N,Inagawa S,Takehara Y,Sakaguchi T,Konno H,Nakamura S.Effect of a portal venous stent for gastrointestinal hemorrhage from jejunal varices caused by portal hypertension after pancreatoduodenectomy.J Hepatobiliary Pancreat Surg 2005;12:88-92[PMID:15754107DOI:10.1007/s00534-004-0941-4]
41 Nosher JL,Chung J,Brevetti LS,Graham AM,Siegel RL.Visceral and renal artery aneurysms:a pictorial essay on endovascular therapy.Radiographics 2006;26:1687-1704;quiz1687[PMID:17102044 DOI:10.1148/rg.266055732]
42刘金钢,刘东峰,余云.胰十二指肠切除术后吻合口出血的内镜治疗.中华消化内镜杂志2002;l9:242-243
43苗毅,林士波,高文涛.胰十二指肠切除术后出血的治疗策略.中华外科杂志2014;52:1668-1670
44 Darnis B,Lebeau R,Chopin-Laly X,Adham M.Postpancreatectomy hemorrhage(PPH):predictors and management from a prospective database.Langenbecks Arch Surg 2013;398:441-448[PMID:23435636 DOI:10.1007/s00423-013-1047-8]
45 Roulin D,Cerantola Y,Demartines N,Sch?fer M.Systematic review of delayed postoperative hemorrhage after pancreatic resection.J Gastrointest Surg 2011;15:1055-1062[PMID:21267670 DOI:10.1007/s11605-011-1427-8]
46 Herzog T,Sülberg D,Belyaev O,Uhl W,Seemann M,Seelig MH.Treatment of acute delayed visceral hemorrhage after pancreatic surgery from hepatic arteries with covered stents.J Gastrointest Surg 2011;15:496-502[DOI:10.1007/s11605-010-1260-5]
47 Amini A,Christians KK,Evans DB.Postpancreatectomy Hemorrhage:Early and Late.Gastrointest Sur 2015;271-280[DOI 10.1007/978-1-4939-2223-9_26]
48孙备,宋增福,姜洪池.快速康复在胰腺外科中应用的现状与争论.中国实用外科杂志2011;31:897-901
49施晨晔,许雪峰,王单松,靳大勇,匡天涛,楼文晖.胰腺切除术后围手术期主要并发症卫生经济学分析.中国实用外科杂志2012;32:573-575
2 Tien YW,Lee PH,Yang CY,Ho MC,Chiu YF.Risk factors of massive bleeding related to pancreatic leak after pancreaticoduodenectomy.J Am Coll Surg 2005;201:554-559[PMID:16183493 DOI:10.1016/j.jamcollsurg.2005.05.007]
3 Povoski SP.Novel applications of Endo GIA linear staplers during pancreaticoduodenectomy and total pancreatectomy.Am J Surg 2001;182:77-80[PMID:11532422 DOI:10.1016/S0002-9610(01)00650-X]
4刘兴贵,孙诚谊,胡韵.一次性直线型切割吻合器在胰十二指肠切除术中的应用.贵阳医学院学报2004;29:461-462[DOI:10.19367/j.cnki.1000-2707.2004.05.035]
5彭淑牖,刘颖斌,李海军.外科器械应用新进展--胰十二指肠切除术后出血的防治及PMOD的应用.中国现代手术学杂志2004;8:262-264[DOI:10.16260/j.cnki.1009-2188.2004.05.002]
6倪克梁,彭淑牖,崔健.胰十二指肠切除术并发症的预防.肝胆胰外科杂志2002;14:239-240
7 Balachandran P,Sikora SS,Raghavendra Rao RV,Kumar A,Saxena R,Kapoor VK.Haemorrhagic complications of pancreaticoduodenectomy.ANZ J Surg 2004;74:945-950[PMID:15550080 DOI:10.1111/j.1445-1433.2004.03212.x]
8 Srivastava S,Sikora SS,Kumar A,Saxena R,Kapoor VK.Outcome following pancreaticoduodenectomy in patients undergoing preoperative biliary drainage.Dig Surg 2001;18:381-387[PMID:11721113 DOI:10.1159/000050178]
9 Yoshida T,Ninomiya S,Matsumata T.Management of bleeding pseudoaneurysms after pancreatoduodenectomy.Arch Surg 2003;138:458[PMID:12686535 DOI:10.1001/archsurg.138.4.458-a]
10 Choi SH,Moon HJ,Heo JS,Joh JW,Kim YI.Delayed hemorrhage after pancreaticoduodenectomy.J Am Coll Surg2004;199:186-191[PMID:15275871 DOI:10.1016/j.jamcollsur g.2004.04.005]
11 Yoon YS,Kim SW,Her KH,Park YC,Ahn YJ,Jang JY,Park SJ,Suh KS,Han JK,Lee KU,Park YH.Management of postoperative hemorrhage after pancreatoduodenectomy.Hepatogastroenterology 2003;50:2208-2212[PMID:14696500]
12 Sewnath ME,Birjmohun RS,Rauws EA,Huibregtse K,Obertop H,Gouma DJ.The effect of preoperative biliary drainage on postoperative complications after pancreaticoduodenectomy.J Am Coll Surg 2001;192:726-734[PMID:11400966]
13 Hodul P,Creech S,Pickleman J,Aranha GV.The effect of preoperative biliary stenting on postoperative complications after pancreaticoduodenectomy.Am J Surg 2003;186:420-425[PMID:14599600 DOI:10.1016/j.amjsurg.2003.07.005]
14张和,孙备,白雪巍,陈华,李军,谭宏涛,姜洪池.胰腺中段切除术29例临床分析.中国普外基础与临床杂志2013;20:1045-1048
15 Oida T,Mimatsu K,Kawasaki A,Kanou H,Kuboi Y,Kida K,Amano S.Transduodenal pancreatic juice drainage for preventing pancreatic fistula formation after distal pancreatectomy.Hepatogastroenterology 2011;58:177-182[PMID:21510310]
16李乐,孙备,姜洪池.保留脾脏胰腺远端切除术专家共识.中国实用外科杂志2014;34:6-9
17 Balzano G,Zerbi A,Di Carlo V.Spleen-preserving distal pancreatectomy with excision of splenic artery and vein:a cautionary note.World J Surg 2007;31:1530;author reply 1531[PMID:17487525 DOI:10.1007/s00268-007-9055-x]
18 Jain G,Chakravartty S,Patel AG.Spleen-preserving distal pancreatectomy with and without splenic vessel ligation:a systematic review.HPB(Oxford)2013;15:403-410[PMID:23458666 DOI:10.1111/hpb.12003]
19 Rieder B,Krampulz D,Adolf J,Pfeiffer A.Endoscopic pancreatic sphincterotomy and stenting for preoperative prophylaxis of pancreatic fistula after distal pancreatectomy.Gastrointest Endosc 2010;72:536-542[PMID:20598301 DOI:10.1016/j.gie.2010.04.011]
20申宏,王功锦,亢朝胜,王振波,粟劲松,蔡吉亮,邓祖龙.胰腺损伤的外科治疗体会.肝胆胰外科杂志2009;17:295-296
21 Debi U,Kaur R,Prasad KK,Sinha SK,Sinha A,Singh K.Pancreatic trauma:a concise review.World J Gastroenterol2013;19:9003-9011[PMID:24379625 DOI:10.3748/wjg.v19.i47.9003]
22 Antonacci N,Di Saverio S,Ciaroni V,Biscardi A,Giugni A,Cancellieri F,Coniglio C,Cavallo P,Giorgini E,Baldoni F,Gordini G,Tugnoli G.Prognosis and treatment of pancreaticoduodenal traumatic injuries:which factors are predictors of outcome?J Hepatobiliary Pancreat Sci 2011;18:195-201[PMID:20936305 DOI:10.1007/s00534-010-0329-6]
23冀亮,孙备,程春东,白雪巍,王刚,孔瑞,陈华,姜洪池.创伤递升式分阶段治疗重症急性胰腺炎局部并发症的临床经验总结.中华外科杂志2016;54:839-843
24姜脉涛,宋增福,姜洪池,孙备,白雪巍.胰腺术后出血预防及诊治研究(附518例胰腺手术分析).中国实用外科杂志2015;35:316-321
25董齐,董明.预防和治疗手术后应激性溃疡的现代策略.中国实用外科杂志2006;26:65-67
26 Felder LR,Barkin JS.A comparison of omeprazole and placebo for bleeding peptic ulcer.Gastrointest Endosc 1998;47:428-429[PMID:9609447 DOI:10.1016/S0016-5107(98)90003-1]
27 Lau JY,Sung JJ,Lee KK,Yung MY,Wong SK,Wu JC,Chan FK,Ng EK,You JH,Lee CW,Chan AC,Chung SC.Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers.N Engl JMed 2000;343:310-316[PMID:10922420 DOI:10.1056/NEJM200008033430501]
28 Tsirlis T,Vasiliades G,Koliopanos A,Kopanakis N,Katseli A,Tsipras H,Margaris H.Pancreatic leak related hemorrhage following pancreaticoduodenectomy.A case series.JOP 2009;10:492-495
29 Zografos GN,Kopanakis N,Vasiliades G,Perysinakis H,Vaidakis D,Avlonitis S,Margaris I,Tsipras I.Pancreatic fistula following distal pancreatectomy:How to prevent.Hell J Surg 2012;84:335-339[DOI:10.1007/s13126-012-0055-4]
30 Kuroki T,Tajima Y,Kanematsu T.Surgical management for the prevention of pancreatic fistula following distal pancreatectomy.J Hepato-Biliary-Pan 2005;12:283-285[DOI:10.1007/s00534-005-0990-3]
31 Wellner UF,Kulemann B,Lapshyn H,Hoeppner J,Sick O,Makowiec F,Bausch D,Hopt UT,Keck T.Postpancreatectomy hemorrhage--incidence,treatment,and risk factors in over1,000 pancreatic resections.J Gastrointest Surg 2014;18:464-475[PMID:24448997 DOI:10.1007/s11605-013-2437-5]
32 Yekebas EF,Wolfram L,Cataldegirmen G,Habermann CR,Bogoevski D,Koenig AM,Kaifi J,Schurr PG,Bubenheim M,Nolte-Ernsting C,Adam G,Izbicki JR.Postpancreatectomy hemorrhage:diagnosis and treatment:an analysis in 1669consecutive pancreatic resections.Ann Surg 2007;246:269-280[PMID:17667506 DOI:10.1097/01.sla.0000262953.77735.db]
33 Imperiale TF,Birgisson S.Somatostatin or octreotide compared with H2 antagonists and placebo in the management of acute nonvariceal upper gastrointestinal hemorrhage:a meta-analysis.Ann Intern Med 1997;127:1062-1071[PMID:9412308 DOI:10.7326/0003-4819-127-12-199712150-00002]
34 Clarke DL,McKune A,Thomson SR.Octreotide lowers gastric mucosal blood flow in normal and portal hypertensive stomachs.Surg Endosc 2003;17:1570-1572[PMID:12874677DOI:10.1007/s00464-002-9274-z]
35 Poon RT,Lo SH,Fong D,Fan ST,Wong J.Preven-tion of pancreatic anastomotic leakage after pancreaticoduodenectomy.Am J Surg 2002;183:42-52[PMID:11869701 DOI:10.1016/S0002-9610(01)00829-7]
36 Shan YS,Sy ED,Lin PW.Role of somatostatin in the prevention of pancreatic stump-related morbidity following elective pancreaticoduodenectomy in high-risk patients and elimination of surgeon-related factors:prospective,randomized,controlled trial.World J Surg 2003;27:709-714[PMID:12732998 DOI:10.1007/s00268-003-6693-5]
37史佩东,薛利军,尹浩然.胰腺损伤的诊断与手术治疗探讨(附34例报告).肝胆胰外科杂志2008;20:397-399
38 Otah E,Cushin BJ,Rozenblit GN,Neff R,Otah KE,Cooperman AM.Visceral artery pseudoaneurysms following pancreatoduodenectomy.Arch Surg 2002;137:55-59[PMID:11772216 DOI:10.1001/archsurg.137.1.55]
39 Khalsa BS,Imagawa DK,Chen JI,Dermirjian AN,Yim DB,Findeiss LK.Evolution in the Treatment of Delayed Postpancreatectomy Hemorrhage:Surgery to Interventional Radiology.Pancreas 2015;44:953-958[PMID:25906453 DOI:10.1097/MPA.0000000000000347]
40 Ota S,Suzuki S,Mitsuoka H,Unno N,Inagawa S,Takehara Y,Sakaguchi T,Konno H,Nakamura S.Effect of a portal venous stent for gastrointestinal hemorrhage from jejunal varices caused by portal hypertension after pancreatoduodenectomy.J Hepatobiliary Pancreat Surg 2005;12:88-92[PMID:15754107DOI:10.1007/s00534-004-0941-4]
41 Nosher JL,Chung J,Brevetti LS,Graham AM,Siegel RL.Visceral and renal artery aneurysms:a pictorial essay on endovascular therapy.Radiographics 2006;26:1687-1704;quiz1687[PMID:17102044 DOI:10.1148/rg.266055732]
42刘金钢,刘东峰,余云.胰十二指肠切除术后吻合口出血的内镜治疗.中华消化内镜杂志2002;l9:242-243
43苗毅,林士波,高文涛.胰十二指肠切除术后出血的治疗策略.中华外科杂志2014;52:1668-1670
44 Darnis B,Lebeau R,Chopin-Laly X,Adham M.Postpancreatectomy hemorrhage(PPH):predictors and management from a prospective database.Langenbecks Arch Surg 2013;398:441-448[PMID:23435636 DOI:10.1007/s00423-013-1047-8]
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