胰腺术后迟发性出血的介入治疗

Interventional management of delayed post-pancreatectomy hemorrhage

目的探讨血管内介入治疗胰腺术后迟发性出血的安全性和有效性。方法搜集2010年1月至2017年6月因胰腺术后迟发性出血行造影检查的61例患者的资料,临床表现为腹腔出血47例,消化道出血14例。评价介入治疗的疗效、再出血率及并发症,分析再出血部位及再治疗成功率。结果 47例(77.0%)造影为阳性表现患者全部行血管内介入治疗,其中单纯弹簧圈栓塞30例,弹簧圈联合明胶海绵颗粒15例,覆膜支架植入2例。介入治疗技术成功率、临床成功率和再出血率分别为97.9%(46/47)、72.3%(34/47)和27.7%(13/47)。首次介入治疗后再出血的中位时间为2d(0～30 d),53.8%(7/13)再出血部位为原栓塞动脉。再出血患者中5例(5/8)行二次介入治疗成功止血。所有患者介入术后未出现肠道、肝脏缺血坏死等严重并发症。术后30 d死亡率为8.5%(4/47),其中3例死于介入术后再出血。结论血管内介入是治疗迟发性胰腺术后出血一种安全、有效的方法,大部分患者通过单纯介入治疗成功止血。

Objective To evaluate the safety and efficacy of endovascular interventional management in treating delayed post-pancreatectomy hemorrhage （PPH）. Methods The clinical data of 61 patients, who received angiography because of delayed PPH during the period from January 2010 to June 2017, were collected. The clinical manifestations included hemorrhage in abdominal cavity （n=47） and hemorrhage of digestive tract （n=14）. The effect of interventional therapy was evaluated, and the re-bleeding rate and incidence of complications were calculated. The re-bleeding site and the re-treatment success rate were analyzed. Results Endovascular interventional therapy was carried out in all 47 patients who had positive signs of bleeding on angiography. Embolization therapy with pure spring coils was performed in 30 patients, with spring coils plus gelfoam particles in 15 patients, and with covered stent in 2 patients. The technical success rate, clinical success rate and re-bleeding rate of interventional therapy were 97.9% （46/47）, 72.3% （34/47） and 27.7% （13/47） respectively. The median interval time from initial interventional therapy to onset of re-bleeding was 2 days （0-30 days）. In 53.8% of patients （7/13） the re-bleeding site was the previously embolized artery. Among the 8 patients who developed re-bleeding, 5 patients （62.5%, 5/8） had to receive secondary interventional therapy, and the bleeding was successfully controlled. No severe complications such as gastrointestinal or hepatic ischemie necrosis occurred in all patients. The overall 30-day mortality was 8.5% （4/47） and 3 patients among them died of re-bleeding. Conclusion For the treatment of delayed post- panereateetomy hemorrhage, endovascular interventional therapy is safe and effective. Simple interventional therapy can successfully stop bleeding in most patients.