介入治疗胰十二指肠切除术后晚期出血

Interventional therapy of late hemorrhage after postpancreatectomy

目的观察介入治疗胰十二指肠切除术后晚期出血的效果。方法回顾性分析50例胰十二指肠切除术后晚期出血患者,其中42例接受血管造影检查,之后28例接受单纯介入治疗、14例经介入治疗后转外科手术;8例直接接受外科手术探查。观察血管造影表现,记录介入治疗方案,分析止血效果。结果50例总体止血成功率66.00%(33/50),死亡率34.00%(17/50);单纯介入治疗止血成功率82.14%(23/28),死亡率17.86%(5/28)。42例血管造影中,26例可见阳性征象,其中假性动脉瘤[46.15%(12/26)]最常见,肝固有/肝总动脉[53.85%(14/26)]最常受累;其中24例主要以弹簧圈栓塞,包括8例单纯弹簧圈、12例采用弹簧圈联合明胶海绵颗粒及4例以弹簧圈联合PVA颗粒进行栓塞;2例于肝动脉植入覆膜支架。结论介入治疗对胰十二指肠切除术后晚期出血止血效果较好。

Objective To observe the effect of interventional therapy for late hemorrhage after postpancreatectomy.Methods Totally 50 patients with late hemorrhage after postpancreatectomy were retrospectively analyzed.Among 50 patients,42 underwent transcatheter arterial angiographies,and then 28 of them underwent only interventional therapy,while 14 were converted to surgical treatment after interventional therapy.Direct surgical exploration was performed in the rest 8 cases.The angiographic features and responsible vessels for bleeding were observed,and perioperative results were recorded.Results For all 50 patients,stop bleeding rate was 66.00%(33/50),and the mortality rate was 34.00%(17/50),while for pure interventional therapy,stop bleeding rate was was 82.14%(23/28)and the death rate was 17.86%(5/28).Among 42 patients underwent angiography,positive findings were observed in 26 patients,pseudoaneurysm was the most common bleeding sign(46.15%[12/26]),and hepatic intrinsic/common artery were the most involved vessels(53.85%[14/26]).Among 26 cases with positive angiography,24 underwent embolization based on coils,including 8 with coils only,12 with coils combined with gelatin sponge particles and 4 with coils combined with PVA particles,while 2 cases were treated with covered stents implantation of hepatic artery.Conclusion Interventional therapy is effective for treatment of late hemorrhage after postpancreatectomy.