介入治疗胃胆胰术后迟发性出血的临床疗效与安全性

Interventional treatment for delayed postoperative hemorrhage after gastric and pancreatic-biliary surgery

目的探讨介入治疗胃胆胰术后迟发性出血临床疗效与安全性。方法回顾性分析2016年1月至2021年6月南京医科大学第二附属医院胃胆胰术后迟发性出血24例患者的临床资料。主要观察指标为技术成功率和临床有效率,次要观察指标为介入相关并发症。结果所有病例动脉造影均明确出血责任动脉,诊断阳性率100%。2例栓塞治疗失败行外科手术治疗,总体技术成功率91.7%。术后15例治愈出院;4例再次出血行二次介入治疗,3例住院期间死亡,总体临床有效率62.5%。介入相关并发症包括肝脏缺血5例,肝脏梗塞2例,脾脏梗塞2例,总体并发症发生率37.5%。根据出血责任动脉不同分为肝外肝动脉组(n=11)和其他动脉组(n=13),两组技术成功率和临床有效率差异无统计学意义(P>0.05),但是两组并发症发生率差异有统计学意义(P=0.033)。结论介入治疗胃胆胰术后迟发性出血诊断阳性率高,治疗效果确切,严重并发症少见,可作为首选方法。

Objective To evaluate the clinical efficacy and safety of interventional treatment for delayed hemorrhage after gastric and pancreatic-biliary surgery.Methods The clinical data of 24 patients with delayed hemorrhage after gastric and pancreatic-biliary surgery treated by the authors'hospital from January 2016 to June 2021 were retrospectively analyzed.The primary endpoints were the technical success and the clinical efficacy rate,and the secondary endpoints were interventional treatment-related complications.Results The responsible arteries were identified by angiography in all cases,and the diagnostic positive rate was 100%.Embolization failed in two cases which underwent the second surgery,and the overall technical success rate was 91.7%.15 cases were cured and discharged after treatment.The second interventional treatment was performed in 4 cases with recurrent bleeding,and 3 patients died during hospitalization.The overall clinical efficacy rate was 62.5%.The interventional treatment-related complications included liver ischemia in 5 cases,liver infarction in 2 cases and spleen infarction in 2 cases.The overall complication rate was 37.5%.The cases were divided into the extrahepatic hepatic artery group(n=11)and the other artery group(n=13)according to different responsible arteries.There was no significant difference in the technical success rate and the clinical efficacy rate between the two groups(P>0.05),but the difference of the interventional treatmentrelated complication rate between the two groups was significant(P=0.033).Conclusion Interventional treatment could be the first choice for delayed hemorrhage after gastric and pancreatic-biliary surgery due to its high diagnostic positive rate,definite therapeutic effect and rare serious complications.