经导管动脉栓塞治疗胆胰十二指肠区术后出血的临床分析

Clinical analysis on the effect of transcatheter arterial embolization in the treatment of postoperative bleeding in the biliopancreatoduodenal region

目的探讨经导管动脉栓塞(TAE)治疗胆胰十二指肠区术后出血的临床应用效果。方法回顾性分析2018年7月至2022年8月间中国医学科学院北京协和医院39例因怀疑胆胰十二指肠区术后出血行数字减影血管造影(DSA)检查患者的临床资料,比较经TAE治疗和未经TAE治疗患者的临床转归,采用Kappa检验分析DSA与增强CT对出血提示的一致性。结果39例患者中,DSA检查提示出血患者26例(66.7%),分别为胃十二指肠动脉出血4例,肝总动脉及分支6例,肠系膜上动脉及分支6例,胰十二指肠动脉及分支4例,胰大动脉3例,脾动脉2例,胃左动脉1例。DSA阳性征象表现为单纯对比剂外溢18例(69.2%),单纯假性动脉瘤7例(26.9%),假性动脉瘤伴对比剂外溢1例(3.8%)。26例经TAE治疗,技术成功率为96.2%(25/26),临床成功率为88.5%(23/26),再出血率为7.7%(2/26)。13例未经TAE治疗,再出血率为30.8%(4/13)。14例患者行DSA同期的增强CT检查,在判断是否出血方面,与DSA一致性较低,Kappa值为0.462。结论TAE对胆胰十二指肠区术后出血的治疗是安全、有效的。未进行TAE治疗的患者,需警惕再出血。怀疑术后出血时,增强CT检查与DSA检查结果一致性有限,DSA检查可直接作为首选检查。

Objective To investigate the efficacy of transcatheter arterial embolization(TAE)in treating postoperative hemorrhage in the gallbladder-pancreas-duodenum(GPD)region.Methods The clinical data of 39 patients with postoperative hemorrhage in the GPD region who underwent digital subtraction angiography(DSA)examination in Peking Union Medical College Hospital from July 2018 to August 2022 were analyzed retrospectively,clinical regression was compared between TAE-treated and non-TAE-treated patients,and the concordance between DSA and enhanced CT for bleeding indications was analyzed using the Kappa test.Results Among 39 patients,DSA examination suggested bleeding in 26 patients(66.7%),which were gastroduodenal artery hemorrhage in 4 cases,common hepatic artery and branches in 6 categories,superior mesenteric artery and branches in 6 cases,pancreaticoduodenal artery and branches in 4 cases,pancreatic aorta in 3 cases,splenic artery in 2 cases,and gastric left artery in 1 case.Positive DSA signs manifested as contrast spillage alone in 18 cases(69.2%),pseudoaneurysm alone in 7 cases(26.9%),and pseudoaneurysm with contrast spillage in 1 case(3.8%).26 patients underwent TAE with a technical success rate of 96.2%(25/26),a clinical success rate of 88.5%(23/26)and a rebleeding rate of 7.7%(2/26).13 patients didn't undergo TAE and the rebleeding rate was 30.8%(4/13).14 patients underwent enhanced CT in the same period of DSA,showed low concordance with DSA in determining the presence or absence of bleeding,with a Kappa value of 0.462.Conclusions TAE is a safe and effective treatment for postoperative hemorrhage in the GPD region.Patients without TAE treated should be alert for rebleeding.When postoperative hemorrhage is suspected,the consistency between enhanced CT and DSA examination results is limited,and DSA examination should be preferred.