目的 探讨胰十二指肠切除术后出血的原因及其预防和治疗措施。方法 对我院1977~2002年期间210例胰十二指肠切除术病例进行回顾性分析。结果 发生术后出血39例（18.6%），其中上消化道出血33例次（15.7%），腹腔内出血10例次（4.8%）。术后死亡的18例中14例合并术后出血； 出血合并其他并发症患者的死亡率（57.1%，12/21）明显高于单纯出血病例（11.1%，2/18），与出血并存的并发症中以吻合口漏、腹腔内感染和肝、肾功能衰竭最为常见。近两年来术后出血率（10.5%）较90年代（19.8%）和90年代前（26.2%）减少。术后出血患者术前总胆红素≥342 μmol/L者的比例及术中出血和输血量均明显高于未出血病例。结论 精细熟练的操作、严密吻合、彻底止血及有效预防其他并发症的发生是减少术后出血及死亡的关键，术前重度黄疸、术中大量出血和输血将增加患者术后出血的危险性。
Objective To investigate the extent of hepatic ischemia reperfusion (HIR) injury in rat cirrhotic liver under different ischemic time，and find the time limit under which the rat with cirrhotic liver could tolerate. Methods At first，the cirrhosis of the rat were induced by carbon tetrachloride（CCl4）injected subcutaneously. Then these rats were randomly divided into four groups. Group A(n=6) was made by sham operation, group B, C, D(n=16) were respectively given 20, 30, 40min hepatic warm ischemia. The 7day survival rate, AST, ALT, TNF and liver, pulmonary pathology were observed. Results The 7-day survival rate was decreased with the increase of hepatic ischemic time. The survival rate of group B, C, D were respectively 100%, 60%, 40%. Between group C, D and group B there were significant differences（P＜0.05）. The level of AST and ALT in group D were （2 448.4±942.3）u/L and （1 189.0±403.4）u/L respectively, and those in group C were （2 185.1±1 732.9）u/L and （1 183.5±707.2）u/L respectively, which were higher than those in group B and A significantly（P＜0.01）. The level of TNF was increased significantly 4hr after reperfusion, as compared with that before operation 〔(0.177±0.139）u/ml〕, P＜0.01. TNF of group B, C, D were （0.399±0.216）u/ml, （0.671±0.351）u/ml and （0.789±0.371）u/ml respectively. At the same time the level of TNF in group C, D was higher than that in group B, A significantly（P＜0.01）. Liver and lung pathology showed increased damage with increasing ischemia. Conclusion Hepatic injury is induced by HIR in rats with cirrhotic liver, and its severity increases with the increase of ischemic time. There is a certain hepatic ischemic time between 20min and 30min, which can be tolerated by the rats with cirrhotic liver. TNF may be used as an indicator，showing the degree of HIR injury and foreseeing the result of injury.