[Show abstract][Hide abstract] ABSTRACT: To investigate the diagnosis and treatment of delayed post-pancreaticoduodenectomy arterial bleeding (DPPAB).
Records of 336 patients who underwent pancreaticoduodenectomy (PD) between January 2000 and December 2010 were retrospectively analyzed. Detailed data of patients with DPPAB were assessed by a thorough review of medical records.
14 patients developed DPPAB. The mean time interval between the initial surgery and DPPAB was 33 days (range 7-72). Three patients experienced sentinel bleeding 5-8 days before DPPAB. All DPPAB patients had intra-abdominal septic complications before bleeding. The overall prevalence of success of angiography and transcatheter arterial embolization (TAE) was 85.7% (12/14), including 3 patients who achieved complete hemostasis by TAE after unsuccessful re-laparotomy. The prevalence of mortality of DPPAB was 28.6% (4/14). After hemostasis was achieved, intra-abdominal septic complications were controlled by percutaneous catheter drainage or re-laparotomy with drain replacement.
Angiography and TAE are recommended as the first-line diagnostic and treatment choice for DPPAB, respectively. Surgical intervention should be preserved to eliminate the cause of bleeding.
[Show abstract][Hide abstract] ABSTRACT: To establish a scoring system predicting the ascites postoperatively by analyzing the variant factors associated with massive ascites after hepatectomy in the patients with hepatocellular carcinoma (HCC).
From January 2005 to January 2010, 324 patients with HCC underwent hepatectomy were analyzed retrospectively. There were 282 male and 42 female, aging from 17 to 84 years (mean age, 54 years). They were divided into two groups according to the volume of ascites. Variant preoperative, intraoperative and postoperative factors were compared and a scoring system was established to predict the postoperative ascites.
The univariate analyses revealed that various preoperative factors including prothrombin time, activated partial thromboplastin time, platelet count, albumin, aspartate aminotransferase had significantly difference in the two groups (P < 0.05). The operation time, intraoperative bleeding, hemihepatectomy or extended hemi-hepatectomy and the request of blood and serum transfusion had significantly difference in the two groups (P < 0.05). The multivariate analysis showed that the PLT, AST and the intraoperative plasma transfusion, hemihepatectomy or extended hemi-hepatectomy, the urine output and the drainage in the first postoperative day were independent factors (P < 0.05) for ascites. A scoring system was established based on the analysis. The specificity and the sensitivity were 86.2% and 83.3% respectively.
Variant factors are associated with postoperative ascites for hepatocellular carcinoma and the scoring system established can predict the ascites after hepatectomy accurately.
No preview · Article · Oct 2010 · Zhonghua wai ke za zhi [Chinese journal of surgery]