数字减影血管造影用于重症胰腺炎并发出血患者诊断及介入治疗  

Diagnosis and Interventional Treatment of Digital Subtraction Angiography for Patients with Hemorrhagic Complication of Severe Pancreatitis

作　　者：袁磊[1] 陈波[2] 许潭潭 史东宏[2] 曹建民[2] 卢光明[2] 许健[2] 

机构地区：[1]徐州医学院研究生院,江苏徐州221000 [2]南京军区南京总医院医学影像科,江苏南京210002

出　　处：《现代生物医学进展》2014年第19期3680-3683,共4页Progress in Modern Biomedicine

基　　金：国家自然科学基金项目(81300360)

摘　　要：目的:探讨数字减影血管造影(DigitalSubtractionAngiography,DSA)诊断及介入治疗重症胰腺炎(Severe panreatitis,SP)并发出血的临床疗效。方法:回顾性分析2009年1月-2013年11月南京军区总医院收治的42例SP并发出血患者行动脉造影,发现出血征象时采用微钢圈配合明胶海绵栓塞或经导管灌注缩血管药治疗。观察选择性动脉造影对诊断出血部位及止血效果的价值。结果:通过造影42例患者中28例发现出血征象,出血阳性率为66.7%(28/42),25例通过超选择栓塞以控制出血,初次止血率89.2%(25/28)。6例栓塞后复发出血,再出血率为24.0%(6/25),4例再行栓塞成功,再止血成功率为66.7%,累计止血成功率为82.1%。3例栓塞后反复出血未能控制,死于多器官功能衰竭,1例栓塞后脾脓肿并行脾切除,1例栓塞后肠缺血。结论:DAS不仅可以快速诊断出血部位,还可以同时进行介入治疗,止血效果肯定。Objective： To investigate the value of diagnosis and interventional treatment of digital subtraction angiography（DSA） for patients with hemorrhagic complication of severe pancreatitis. Methods： During the period from January 2009 to November 2013, a total of 42 patients with hemorrhagic complication of severe pancreatitis, were admitted to authors, hospital. Angiography were carried out in all the patients. The target vessels were embolized by gelfoam and microcoil or were infused vasopressin via catheter. The value of selective arteriography in diagnosis of the bleeding site, and the efficacy ofhemostasis were analyzed. Results： 28 cases of bleeding sites found by angiography, diagnosis of bleeding was 66.7 %（28/42）. Bleeding was controlled in 25 cases with ultraselective embolism. TAE successful hemostasis was 89.2 % （25/28） rebleeding rate was 24.0 % （6/25）. The successful rate of TAE again was 66.7 % （4/6）, with overall success rate of 82.1%. Three cases of recurrent bleeding after embolization failed to control, died of multiple organ failure. One case of splenic abscess after embolization, and another one case of avascular necrosis of the intestine. Conclusions： DAS can not only diagnose quickly the bleeding site, but can also be used simultaneously in intervention with good hemostasis effect.

关 键 词：重症胰腺炎 数字减影血管造影 动脉栓塞 出血 

分 类 号：R576[医药卫生—消化系统]