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。
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．
关键词
胰十二指肠切除术 /
出血 /
栓塞 /
治疗性
Key words
Pancreaticoduodenectomy /
Hemorrhage /
Embolization, theraprutic
中图分类号：
Ｒ657.5
Ｒ656.64
Ｒ815
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