介入治疗在胰十二指肠切除术后出血的临床应用  

Clinical application of interventional therapy for hemorrhage after pancreaticoduodenectomy

作　　者：方主亭[1] 唐仪[1] 吴少杰[1] 周艳峰[1] 杨厚林[1] 陈良生[1] FANG Zhuting;TANG Yi;WU Shaojie;ZHOU Yanfeng;YANG Houlin;CHEN Liangsheng(Department of Interventional Radiology y Fujian Provincial Hospital,Provincial Clinical Medical College of Fujian Medical University,Fuzhou,Fujian Province 350001,China)

机构地区：[1]福建省立医院(福建医科大学省立临床医学院)介入放射科,福州350001

出　　处：《介入放射学杂志》2019年第3期292-295,共4页Journal of Interventional Radiology

基　　金：福建省卫生计生委中青年骨干人材培养项目(2017-2QN-1);福建省立医院院内优秀青年项目(2014YNQN08)

摘　　要：目的探讨胰十二指肠切除术(PD)后出血DSA表现及介入治疗临床效果。方法回顾性分析2014年1月至2018年2月19例在福建省立医院接受DSA检查和介入治疗的19例PD术后出血患者血管造影表现和介入治疗效果。结果 DSA检查发现19例患者中16例表现为对比剂外渗、假性动脉瘤或动脉管腔不光整,阳性率为84.2%(16/19)。DSA检查阳性患者除1例肠系膜上动脉分支出血超选插管困难外,均接受责任血管覆膜支架植入或栓塞治疗,技术成功率为93.8%(15/16);13例止血成功,止血率为86.7%(13/15);2例栓塞治疗后再出血患者转外科手术治疗。2例接受2次造影,结果 1例为胃十二指肠动脉假性动脉瘤形成,予栓塞成功,另1例仍阴性,转外科手术。结论 DSA及介入治疗对PD术后出血具有诊断和治疗价值,微创且显效,值得临床推广应用。Objective To discuss the angiographic manifestations of hemorrhage after pancreaticoduo-denectomy(PD),and to evaluate the clinical curative effect of interventional therapy.Methods The angiographic findings and the therapeutic effect of interventional therapy for hemorrhage after PD in 19 PD patients,who were admitted to Fujian Provincial Hospital,China,during the period from January 2014 to February 2018 to receive DSA examination and interventional therapy,were retrospectively analyzed.Results Among the 19 PD patients,DSA examination showed that extravasation of contrast medium,pseudoaneurysm formation and irregular arterial lumen were observed in 16 patients,the rate of positive signs was 84.2%(16/19).All the 16 patients,who had positive DSA findings,received covered-stent implantation or embolization therapy for the responsible artery,except one patient who had hemorrhage from the branch of superior mesenteric artery and the super-selective catheterization for him failed.The technical success rate was 93.8%(15/16).Successful hemostasis was achieved in 13 patients(86.7%,13/15).Two patients developed recurrent bleeding and were transferred to surgical treatment.Two patients received twice angiography,the resultsshowed that pseudoaneurysm formation of gastroduodenal artery was detected in one patient,which was treated with embolization therapy,and in another patient angiography was normal and this patient was transferred to surgical treatment.Conclusion For postoperative hemorrhage of PD,DSA has diagnostic value,while interventional therapy has therapeutic value.The techniques are minimally-invasive and highlyeffective.Therefore,it is worthy of clinical popularization and application.

关 键 词：胰十二指肠切除术 术后出血 数字减影血管造影 介入治疗 

分 类 号：R657.5[医药卫生—外科学]