胰十二指肠切除术后迟发性出血的介入栓塞治疗

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (0 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的：探讨介入栓塞技术治疗胰十二指肠切除术（PD）后迟发性出血的安全性和有效性。方法：搜集2010年7月—2015年6月因PD术后迟发性出血行介入治疗的24例患者的临床及影像学资料，分析其造影表现、栓塞效果及相关并发症等。其中男16例，女8例，年龄37～74岁，腹腔出血者14例、消化道出血者7例、腹腔合并消化道出血者2例，直接表现为失血性休克者1例。结果：24例患者中，22例（91.67%）造影阳性，其中单纯假性动脉瘤12例、假性动脉瘤伴造影剂外渗7例、动脉管壁不规则3例。19例（79.2%，19/24）通过介入栓塞手术的方法止血成功。2例出血未得到有效控制而死于失血性休克；4例并发胰瘘、感染性休克及多脏器功能衰竭，于术后1月内死亡；6例于术后3～16月死于肿瘤进展；余12例随访3～24月未再出现大出血。4例患者出现一过性肝损伤，3例脾动脉栓塞及2例肝动脉栓塞者出现小范围脏器梗死，未出现肠坏死、胰腺坏死等严重并发症。结论：介入栓塞手术是治疗PD术后迟发性出血的安全、有效的技术手段，可做为PD术后迟发性出血患者的首选治疗方法。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	王传卓
	刘兆玉

关键词 ：胰十二指肠切除术, 出血, 栓塞, 治疗性

Abstract：Objective: To discuss the safety and efficacy of interventional therapy for delayed post-pancreaticoduodenectomy hemorrhage． Methods: Twenty-four patients undergoing interventional radiology treatments for delayed post-pancreaticoduodenecomy hemorrhage from July 2010 to June 2015 were included in the study. Clinical and imaging data were studied. Angiography findings, efficacy of embolization, and related complications were analyzed. The patients consisted of 16 males and 8 females with an age range of 37~74 years old. There were 14 patients of abdominal hemorrhage, 7 patients of gastrointestinal hemorrhage, 2 patients of abdominal and gastrointestinal hemorrhage, and 1 patient of hemorrhagic shock. Results: In the 24 patients, 22 patients(91.67%) had positive results of angiography. In the 22 patients, 12 patients showed pseudo-aneurysm, 7 patients showed pseudo-aneurysm and contrast media extravasation, 3 patients showed unsmooth arterial intima. Hemorrhage ceased in 19 patients(79.2%, 19/24) after interventional therapy. Two patients died of hemorrhagic shock. Four patients died of complications such as pancreatic fistula, infection shock and multi-organ failure within 1 month after the interventional therapy. Six patients died of tumor deterioration within 3~16 months. The rest 12 patients did not develop massive hemorrhage within 3~24 months. Four patients showed transient liver damage. Three patients with spleen arterial embolism and 2 patients with hepatic artery embolism showed limited extent of infarction. None of the patients showed severe complications such as intestinal necrosis or pancreatic necrosis. Conclusion: The interventional therapy is a safe and effective technique, and should be the first-line diagnosis and treatment choice for patients with post-pancreaticoduodenectomy hemorrhage．

Key words： Pancreaticoduodenectomy Hemorrhage Embolization, theraprutic

收稿日期: 2016-04-13

PACS:	Ｒ657.5
	Ｒ656.64
	Ｒ815

通讯作者: 刘兆玉，中国医科大学附属盛京医院放射科，110004。E-mail：liuzy@sj-hospital.org

作者简介: 王传卓（1982-），男，辽宁沈阳人，主治医师。E-mail：wangcz@sj-hospital.org

引用本文:

王传卓，刘兆玉. 胰十二指肠切除术后迟发性出血的介入栓塞治疗[J]. 中国临床医学影像杂志, 2016, 27(12): 899-903.
WANG Chuan-zhuo, LIU Zhao-yu. Interventional therapy for delayed post-pancreaticoduodenectomy hemorrhage. JOURNAL OF CHINA MEDICAL IMAGING, 2016, 27(12): 899-903.

链接本文:

http://www.jccmi.com.cn/CN/ 或 http://www.jccmi.com.cn/CN/Y2016/V27/I12/899

[1]Jagad RB, Koshariya M, Kawamoto J, et al. Postoperative hemorrhage after major pancreatobiliary surgery: an update[J]. Hepatogastroenterology, 2008, 55(82-83): 729-737.
[2]Choi SH, Moon HJ, Heo JS, et al. Delayed hemorrhage after pancreaticoduodenectomy[J]. J Am Coll Surg, 2004, 199(2): 186-191.
[3]Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage(PPH): an International Study Group of Pancreatic Surgery(ISGPS) definition[J]. Surgery, 2007, 142(1): 20-25.
[4]Treckmann J, Panl A, Sotiropoulos GC, et al. Sentinel bleeding after pancreaticoduodenectomy: a disregarded sign[J]. J Gastrointest Surg, 2008, 12(2): 313-318.
[5]王志军，王茂强，宋鹏，等. 急诊介入治疗在胰腺疾病外科术后大出血中的应用研究[J]. 中华介入放射学电子杂志，2013，1（2）：92-98.
[6]Limongelli P, Khorsandi SE, Pai M, et al. Management of delayed postoperative hemorrhage after pancreaticoduodenectomy: a meta-analysis[J]. Arch Surg, 2008, 143(10): 1001-1007.
[7]Yekebas EF, Wolfram L, Cataldegirmen G, et al. Postpancreatectomy hemorrhage: diagnosis and treatment: an analysis in 1 669 consecutive pancreatic resections[J]. Ann Surg, 2007, 246(2): 269-280.
[8]Treckmann J, Panl A, Sotiropoulos GC. et al. Sentinel bleeding after pancreaticoduodenectomy: a disregarded sign[J]. J Gastrointest Surg, 2008, 12(2): 313-318.
[9]Tien YW, Wu YM, Liu KL, et al. Angiography is indicated for every sentinel bleed after pancreaticoduodenectomy[J]. Ann Surg Oncol, 2008, 15(7): 1855-1861.
[10]徐海峰，朱旭，陈辉，等. 胰十二指肠切除术后出血的血管造影表现及介入治疗[J]. 中华医学杂志，2013，93（1）：55-57.
[11]Iswanto S, Nussbaum ML. Hepatic artery pseudoaneurysm after surgical treatment for pancreatic caner: minimally invasive angiographic techniques as the preferred treatment[J]. N Am J Med Sci, 2014, 6(6): 287-290.
[12]Lee JH, Hwang DW, Lee SY, et al. Clinical features and management of pseudoaneurysmal bleeding after pancreatoduodenectomy[J]. Am Surg, 2012, 78(3): 309-317.
[13]王正堂，林海，王勇，等. 胰十二指肠切除术后晚期出血的诊断与治疗[J]. 中华消化外科杂志，2014，13（4）：277-280.
[14]周坦洋，孙军辉，张岳林，等. 胰十二指肠术后出血的DSA诊断及动脉栓塞治疗[J]. 中华医学杂志，2015，95（5）：368-370.
[15]Gwon DI, Ko GY, Sung KB, et al. Endovascular management of extrahepatic artery hemorrhage after pancreatobiliary surgery: clinical features and outcomes of transcatheter arterial embolization and stent-graft placement[J]. Am J Roentgenol, 2011, 196(5): 627-634.
[16]Hur S, Yoon CJ, Kang SG, et al. Transcatheter arterial embolization of gastroduodenal artery stump pseudoaneurysms after pancreaticoduodenectomy: safety and efficacy of two embolization techniques[J]. J Vasc Interv Radiol, 2011, 22(3): 294-301.
[17]Miura F, Asano T, Amano H, et al. Management of postoperative arterial hemorrhage after pancreato-biliary surgery according to the site of bleeding: re-laparotomy or interventional radiology[J]. J Hepatobiliary Pancreat Surg, 2009, 16(1): 56-63.