胰十二指肠切除术后假性动脉瘤破裂出血纠误挽治  

Salvage Treatment of Pseudoaneurysm Rupture Hemorrhage Patient Fllowing Pancreaticoduodenectomy

作　　者：梁耀杰 杜俊东[2] 焦华波[2] 涂玉亮[2] 朱自满[2] 吴雷超 吕金勇[2] 金鑫[2] 

机构地区：[1]辽宁医学院 解放军总医院第一附属医院研究生培养基地,辽宁锦州100048 [2]解放军总医院第一附属医院肝胆胰脾外科,北京100048

出　　处：《临床误诊误治》2015年第1期80-83,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的总结探讨胰十二指肠切除术后并发假性动脉瘤破裂出血的诊疗新思路。方法回顾性分析1例Vater's壶腹部癌行胰十二指肠切除术后并发假性动脉瘤破裂出血的临床资料。结果患者因壶腹部癌行胰十二指肠切除术,术后3周突发脾动脉假性动脉瘤破裂出血,外院行腹腔干弹簧栓及明胶海绵栓塞止血术,术后出现急性肝肾功能损害,待循环功能稳定后转我院。入我院后相继并发低蛋白血症、多发肝脓肿、腹腔脓肿,经多次脓肿穿刺置管引流、静脉营养支持、广谱抗生素等治疗,持续高热,病情反复并渐恶化。停用全胃肠外营养支持、抗生素及其他多种药物治疗,经胃镜行胃空肠造瘘给予肠内营养支持,同时辅以心理疏导及体能锻炼等,病情逐步好转,两个月后患者可下床活动,睡眠、饮食及精神恢复正常,3个月后康复出院。结论外科术后危重症患者的治疗不能过度依赖抗生素、全胃肠外营养,应重视及时微创脓肿引流、加强胃肠内营养及心理疏导,并限制抗生素等多种药物的应用,有助于危重症患者的康复。Objective To explore new ideas for the salvage treatment of pseudoaneurysm rupture hemorrhage patient following pancreaticoduodenectomy. Methods Clinical data of 1 patient with pseudoaneurysm rupture hemorrhage patient after pancreaticoduodenectomy for Vater＇s ampullary carcinoma was retrospectively analyzed,and relevant literature was also reviewed. Results After pancreaticoduodenectomy（3 weeks）,the patient ＇s condition was complicated with the burst of the splenic artery pseudoaneurysm rupture,and after celiac artery spring bolt and gelatin sponge embolization surgery,postoperative hemorrhagic shock,acute liver and kidney dysfunction occurred,and the patient was admitted to our hospital when the circulatory function became stable. Upon admission he developed hypoalbuminemia,multiple liver abscess,abdominal abscess and empyema and after repeated abscess drainage catheter,intravenous nutritional support,broad-spectrum antibiotic therapy,the patient still had persistent fever,and the relapses made the condition worse. Total parenteral nutrition support was suspended and antibiotics and many other medications,endoscopic gastric jejunostomy enteral nutrition support were given,with the secondary psychological counseling and physical exercise,and the condition gradually improved,the patient was able get out of the bed after 2 months. Sleep,diet and mental condition also returned to normal and 3 months later he was discharged.Conclusion Postoperative treatment of critically ill patients should not over-rely on antibiotics and total parenteral nutrition.Attention should be paid promptly to minimally invasive abscess drainage,and enteral nutrition and psychological counseling should be strengthened and the use of antibiotics and other drugs be limited,all of which may be helpful in the rehabilitation of critically ill patients.

关 键 词：胰十二指肠切除术 手术后并发症 动脉瘤 假性 出血 感染 营养支持 抗菌药 误诊 

分 类 号：R656[医药卫生—外科学]