经导管动脉栓塞治疗胰十二指肠切除术后晚期出血  

Transcatheter arterial embolization for treatment of late stage hemorrhage after pancreaticoduodenectomy

作　　者：魏建 尉建安 胡跃峰 苏天昊[1] 孙学栋 尹超 栗荐 朱巍 陈广[1] 金龙[1] WEI Jian;YU Jian'an;HU Yuefeng;SU Tianhao;SUN Xuedong;YIN Chao;LI Jian;ZHU Wei;CHEN Guang;JIN Long(Department of Interventional Radiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院放射介入科,北京100050

出　　处：《中国介入影像与治疗学》2023年第10期600-603,共4页Chinese Journal of Interventional Imaging and Therapy

摘　　要：目的 观察经导管动脉栓塞(TAE)治疗胰十二指肠切除术(PD)后晚期(术后7天以上)出血的效果。方法 回顾性收集12例因PD术后晚期出血而接受TAE并存在C级胰瘘患者,观察血管造影表现,记录栓塞方法及其效果、TAE后并发症及其后2周胰瘘变化等。结果 12例中,6例存在假性动脉瘤,其中3例见于肝固有动脉或肝总动脉、3例见于胃十二指肠动脉;6例消化道出血,3例来源于胰十二指肠下动脉、3例源自胃十二指肠动脉假性动脉瘤。对6例以弹簧圈、6例以弹簧圈+明胶海绵颗粒进行栓塞;12例均有效止血,治疗后均未再发出血。TAE后4例发热(最高体温39.1℃)、2例腹痛;5例肝功能损伤主要表现为转氨酶升高;均经对症治疗后好转。TAE后2周,5例胰瘘分级降为B级、3例降为A级(即生化瘘),4例仍见C级胰瘘。结论 以单一弹簧圈或联合明胶海绵颗粒行TAE治疗PD术后晚期出血安全、有效,且能促进胰瘘愈合。Objective To observe the effect of transcatheter arterial embolization(TAE)for treatment of late stage hemorrhage(>7 days after surgery)after pancreaticoduodenectomy(PD).Methods Twelve patients with grade C pancreatic fistula who underwent TAE for late stage hemorrhage after PD were retrospectively enrolled.The angiographic manifestations of bleeding were observed,the embolization methods,the therapeutic effect,complications and changes of pancreatic fistula 2 weeks after TAE were recorded.Results Among 12 cases,pseudoaneurysms were detected in 6 cases,including 3 cases in proper hepatic artery or common hepatic artery and 3 cases in gastroduodenal artery.Gastrointestinal hemorrhages from the inferior pancreaticoduodenal artery were observed in 3 cases,while from the gastroduodenal artery which complicated with pseudoaneurysm were noticed in other 3 cases.Single coil embolization or coil combined with gelatin sponge particle embolization of the offending vessels of hemorrhage were performed each in 6 cases.TAE was effective in all 12 cases,no further bleeding occurred after TAE.Fever(maximum body temperature 39.1℃)occurred in 4 cases and abdominal pain in 2 cases after TAE,while liver function damage mainly manifested as elevation of transaminase was observed in 5 cases,but all relieved after symptomatic treatments.Two weeks after TAE,the grade of pancreatic fistula decreased to B in 5 cases and to A(biochemical fistula)in 3 cases,while the remaining 4 cases were still found with grade C pancreatic fistula.Conclusion TAE with simple coil or coil combined with gelatin sponge particle for treating late stage hemorrhage after PD was safe and effective,which could also promote the healing of pancreatic fistula.

关 键 词：胰腺肿瘤 手术后出血 栓塞 治疗性 

分 类 号：R735.9[医药卫生—肿瘤] R815[医药卫生—临床医学]