胰十二指肠切除术后迟发性出血行DSA介入栓塞治疗的临床效果

Digital subtraction angiography interventional embolization in treatment for delayed hemorrhage after pancreaticoduodenectomy

目的 探讨胰十二指肠切除术(PD)后患者迟发性出血行数字减影血管造影(DSA)介入栓塞治疗的疗效和临床意义。方法 回顾性分析湖北省中西医结合医院2016年1月至2023年1月31例因PD术后迟发性出血行DSA介入栓塞治疗的临床资料,评估介入治疗的临床效果。结果 本研究PD术后迟发性出血发生率为6.37%(31/487),31例迟发性出血患者中首次DSA阳性22例(71%),14例伴有假性动脉瘤形成。出血部位包括胃十二指肠动脉9例,肝总动脉7例,肠系膜上动脉分支6例,肝固有动脉5例,脾动脉起始3例,胃左动脉1例。行微弹簧圈栓塞12例,微弹簧圈加明胶海绵栓塞8例,覆膜支架9例,明胶海绵栓塞2例。29例(94%)行DSA介入治疗达到彻底止血效果;2例再发出血,行手术止血处理。结论 DSA及栓塞止血创伤小,可精准发现PD术后出血血管,及时进行栓塞,止血效果安全有效,可作为PD术后迟发性出血首选治疗方法。

Objective To investigate the clinical significance and effectiveness of digital subtraction angiography(DSA) and embolization treatment in patients with delayed hemorrhage after pancreaticoduodenectomy(PD).Methods A retrospective analysis was conducted on the clinical data of 31patients,who received DSA interventional embolization treatment for delayed hemorrhage after PD,in Hubei Provincial Hospital of Integrated Chinese and Western Medicine from Jan.2016 to Jan.2023,to assess the clinical effect of interventional treatment.Results The incidence rate of delayed hemorrhage after PD was 6.37%(31/487) in this study.Among the 31 patients,22 had a positive DSA at the first time and 14 had pseudoaneurysm formation.The sites of hemorrhage included 9 cases of gastroduodenal artery,7 cases of hepatic artery,6 cases of superior mesenteric artery branch,5 cases of proper hepatic artery,3 cases of splenic artery origin,and 1 case of left gastric artery.Twelve patients were embolized with microcoils,8 patients were embolized with microcoils and gelfoam,9 patients were treated with covered stent,and 2 patients were embolized with gelfoam.Twentynine patients achieved a complete hemostasis effect after DSA and 2 patients required surgical hemostasis for recurrent bleeding after interventional embolization.Conclusion DSA and embolization treatment have less trauma,can accurately detect the bleeding vessel after PD,and achieve a safe and effective hemostasis effect in time.Therefore,DSA and embolization treatment can be used as the preferred method in treatment of delayed hemorrhage after PD.