重症急性胰腺炎并发假性动脉瘤大出血的诊断及治疗  

Diagnosis and treatment of massive hemorrhage in patients with severe acute pancreatitis complicated with false aneurysms

作　　者：海涛[1] 朱斌[1] 孙家邦[1] 

机构地区：[1]首都医科大学宣武医院普外科,北京市100053

出　　处：《中华肝胆外科杂志》2007年第3期155-157,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的重症急性胰腺炎（SAP）后期出现胰腺及胰周组织坏死、感染，临床上已是非常危重。一旦并发腹腔、胃肠道等处假性动脉瘤破裂大出血，来势凶险，将进一步危及病人的生命，处理非常棘手。因此及时诊断，有效的治疗是挽救病人生命的关键。本文对SAP并发大出血的临床特点和有效的诊治方法进行探讨。方法自1990年10月至2005年9月共收治的急性胰腺炎286例，其中并发胰周血管分支假性动脉瘤破裂大出血12例，回顾性分析其诊断和治疗方法及疗效。结果SAP并发假性动脉瘤大出血12例病人：男10例，女2例，平均年龄51．2岁。病因：胆源性胰腺炎6例，高脂血症3例，甲状旁腺机能亢进危象1例，原因不明2例。12例进行选择性血管造影检查发现病变，10例“一点法”栓塞后获得止血，4例栓塞4～7d后再出血，2例急诊手术缝扎止血；另2例行“两点法”血管栓塞止血。3例病人死于感染和多器官功能不全综合征（MODS）。结论血管造影、胃镜及腹腔穿刺是诊断SAP并发动脉大出血及其发生部位的主要方法；胰腺血运丰富，“两点法”血管栓塞止血及急诊手术是治疗SAP并发大出血的有效手段。Objective The later complications of pancreatic and peripancreatic necrosis or infection are very dangerous for patients with severe acute pancreatitis （SAP）. If the false aneurysms of peritoneal cavity and/or gastrointestinal tract rupture at the same time, they are very difficult to manage. It is very important to timely diagnose and effectively treat the rupture. This study was aimed to investigate the clinical features and treatment of massive hemorrhage in SAP. Methods Twelve patients with massive hemorrhage of the false aneurysms among the 286 patients with SAP treated in our hospital from 1990 to 2005 were retrospectively analyzed. Results Of the 12 patients with an average age of 51.2 years, 10 were male and 2 female. The etiologies were biliary pancreatitis in 6 patients, hyperlipidemia in 3, hyperparathyroidism in 1 and no clear causes in 2. The diagnosis of hemorrhage was confirmed by selective visceral angiography in all the 12 patients. The bleeding in 10 patients was stopped with ＂one point＂ embolization. The rebleeding occurred 4-7 d after the embolization in 4 patients. Of the 4 patients, 2 received ligation of the bleeding vessel at emergency surgery and 2 ＂two point＂ embolization. Three patients died of infection and MODS. Conclusions Angiography, endoscopy and abdominal puncture are the main diagnostic methods for massive hemorrhage of false aneurysms in SAP patients. ＂Two point＂ embolization and emergency surgery are the effective treatment options for the massive hemorrhage.

关 键 词：胰腺炎 胰腺感染 大出血 诊断 手术治疗 

分 类 号：R686[医药卫生—骨科学]