血管内覆膜支架置入与动脉栓塞治疗肝胆胰外科术后出血的疗效对比

Comparative Hemorrhage Efficacy of Transcatheter Artery Embolization and Intravascular Covered Stent Implantation on Patients after Hepatopancreatobiliary Surgery

目的:比较血管内覆膜支架置入与动脉栓塞治疗肝胆胰外科术后出血的疗效。方法:回顾分析2008年5月—2013年1月经数字减影血管造影(digital subtraction angiography,DSA)治疗的28例外科术后出血患者的临床资料。28例中11例行血管内覆膜支架置入治疗,17例行动脉栓塞治疗。结果:行动脉栓塞治疗术后出血的17例患者中,止血成功9例(52.9%),因再次出血而行剖腹探查止血术者5例(29.4%),存活6例(35.4%);行血管内覆膜支架置入治疗术后出血的11例患者中,止血成功10例(90.9%),1例(9.1%)因再次出血而行剖腹探查止血术,存活9例(81.8%)。2组患者止血成功率、存活率差异均有统计学意义(P<0.05),再次手术率差异无统计学意义。经Cox回归分析,组别、是否行再次手术及止血是否成功对存活率有显著影响,差异均有统计学意义(P<0.05),而栓塞次数对存活率无明显影响。结论:相对于传统的动脉栓塞治疗,血管内覆膜支架置入术用于外科术后出血时具有止血成功率高、术后并发症少等优点。

Objective： To compare the hemorrhage efficacy of transcatheter artery embolization（TAE） and intravascular cov- ered stent implantation on patients after hepatopancreatobiliary surgery. Methods： A retrospective study of 28 patients with hemorrhage after surgery from May 2008 to Jan 2013 was undertaken. The hemorrhage efficacy of two modalities was com- pared. Results： In 17 patients treated with TAE,9 patients stopped bleeding, the success rate was 52.9%,5 patients had an open surgical hemostasis, the reoperation rate was 29.4 % ; the survival rate was 35.4 % （6/17）. In 11 patients treated with in- travascular covered stent implantation, 10 patients stopped bleeding, the success rate was 90.9%; 1 patient had an open surgical hemostasis, the reoperation rate was 9.1%; the survival rate was 81.8% （9/11 ）. There were significant differences in the suc- cess rate and the survival rate（P〈0.05）, but not in the reoperation rate. Cox regression analysis showed that group, reopera- tion and stopped bleeding significantly influenced the survival rate. Conclusions： Compared with TAE, intravascular covered stent implantation is a safe and effective treatment for patients with hemorrhage after surgery.