急性胰腺炎引起的腹腔内及消化道出血的治疗

Treatment of intraperitoneal and gastrointestinal tract hemorrhage complicated with acute pancreatitis

目的 :探讨急性胰腺炎引起的腹腔内和消化道出血的治疗方法。方法 :总结 8例急性胰腺炎引起的腹腔内及消化道出血病例的救治经过 ,并复习文献资料 ,阐述发病机理 ,探讨处理方法。 结果 :本组 6例患者为腹腔内或消化道大出血 ,其中 4例行经皮穿刺出血动脉栓塞术 ,3例存活 ;2例行剖腹探查 ,试图缝扎止血 ,但因腹腔内粘连严重 ,手术操作困难 ,出血部位无法确定 ,未能彻底止血。另 2例出血量较少 ,经保守治疗出血停止。 结论 :经皮穿刺出血动脉栓塞术是治疗急性胰腺炎造成的腹腔内或消化道动脉破裂出血的简便、安全、有效的方法。

Objective: Acute bleeding into peritoneal cavity or into gastrointestinal tract is a rare, but frequently fatal complication of acute pancreatitis. Its fatality rate is very high. It is thought that the hemorrhage of this kind is very difficult to manage. Methods: Experience of treating 8 patients with bleeding into peritoneal cavity or into gastrointestinal tract was reported. Literatures were reviewed. Results: In this group, seven patients had acute necrotic pancreatitis and one had hydropic pancreatitis. Six patients were identified in whom bleeding into peritoneal cavity. Bleeding into gastrointestinal tract in the other two patients. Four of eight patients who had massive bleeding were initially emergently treated with percutaneous angiographic embolization of bleeding artery. Three survived. Two of eight patients were initially underwent operative therapy but couldn't succeed, because there is heavy adhesions exited in peritoneal cavity and bleeding blood vessel could not be defined. Another two patients with mild intraperitoneal hemorrhage were cured by nonoperative treatment. Conclusion: Percutaneous angiographic embolization of bleeding artery is an effective, secure and simple method to treat intraperitoneal or gastrointestinal hemorrhage caused by visceral artery eroded due to acute pancreatitis.