重症急性胰腺炎合并出血的影像诊断与介入治疗  

Imaging diagnosis and interventional treatment on hemorrhagic complication of severe acute pancreatitis

作　　者：赵刚[1] 黎少山[1] 崔静[1] 殷涛[1] 胡伟国[1] 钦琦[1] 王春友[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院胰腺外科中心,武汉430022

出　　处：《中华普通外科杂志》2006年第8期585-587,共3页Chinese Journal of General Surgery

摘　　要：目的探讨影像诊断及介入治疗在重症急性胰腺炎患者并发出血时的应用价值。方法回顾性分析本单位1999年3月至2005年9月间收治的32例重症急性胰腺炎并发出血患者的影像诊断及介入治疗的临床资料。结果32例患者中以消化道出血为主者8例,以腹腔出血为主者21例,以假性囊肿内出血为主者3例。26例患者通过血管造影证实为假性动脉瘤破裂出血,其中23例行超选择性栓塞以控制出血,8例行多次栓塞治疗,3例栓塞失败后给予垂体后叶素灌注控制出血。另有3例患者经磁共振血管造影检查证实为胰源性门脉高压导致的静脉破裂出血,其中1例通过介入断流和放置支架控制出血。3例患者未找到出血血管,行手术治疗。32例患者中治愈21例,死亡11例,无1例发生血栓形成及脏器缺血坏死等严重并发症。结论重症急性胰腺炎并发出血时应尽早行血管造影,同时结合增强CT、磁共振血管造影及消化道内镜迅速明确出血部位及原因,介入治疗可作为控制出血的首选治疗措施,必要时行手术治疗。Objective To evaluate imaging diagnosis and interventional therapy for hemorrhagic complications of severe acute pancreatitis （ SAP ）. Method Thirty-two SAP cases complicating severe bleeding admitted from Mar 1999 to Sep 2005 were analyzed. Results There were gastrointestinal tract bleeding in 8 patients, intraabdominal bleeding in 21 cases, and bleeding within pseudocyst in 3 patients, respectively. Bleeding sites of 26 patients were identified with angiography. Bleeding was controlled in 23 cases with uhraselective embolism. Hypophysin infusion was needed to control the bleeding in 3 cases. Magnetic resonance angiography identified venous rupture bleeding from pancreatic portal hypertension in 3 cases. Laparotomy was needed to control bleeding in 3 patients. In this series, 21 patients were cured and 11 patients died. Conclusion Angiography is recommeded in SAP hemorrhagic complication. CT and MRA is helpful to locate the lesion. Interventional embolism is the most important method . Surgery should be performed when interventional treatment fails.

关 键 词：胰腺炎 急性坏死性 出血 血管造影术 栓塞 

分 类 号：R576[医药卫生—消化系统]