朱帝文,谭永华,顾俊鹏,张海潇,鲍应军,曹耿飞,任伟新.介入治疗胰十二指肠切除术后晚期出血[J].中国介入影像与治疗学,2020,17(9):543-547
介入治疗胰十二指肠切除术后晚期出血
Interventional therapy of late hemorrhage after postpancreatectomy
投稿时间:2019-11-12  修订日期:2020-06-20
DOI:10.13929/j.issn.1672-8475.2020.09.007
中文关键词:  胰十二指肠切除术  出血  栓塞,治疗性  血管造影术
英文关键词:pancreaticoduodenectomy  hemorrhage  embolization, therapeutic  angiography
基金项目:
作者单位E-mail
朱帝文 新疆医科大学第一附属医院介入放射科, 新疆 乌鲁木齐 830054  
谭永华 新疆巴州人民医院介入科, 新疆 库尔勒 841000  
顾俊鹏 新疆医科大学第一附属医院介入放射科, 新疆 乌鲁木齐 830054  
张海潇 新疆医科大学第一附属医院介入放射科, 新疆 乌鲁木齐 830054  
鲍应军 新疆医科大学第一附属医院介入放射科, 新疆 乌鲁木齐 830054  
曹耿飞 新疆医科大学第一附属医院介入放射科, 新疆 乌鲁木齐 830054  
任伟新 新疆医科大学第一附属医院介入放射科, 新疆 乌鲁木齐 830054 rwx1031@163.com 
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中文摘要:
      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。
英文摘要:
      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.
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