经导管动脉栓塞术治疗重症急性胰腺炎并发假性动脉瘤破裂出血

目的探讨经导管动脉栓塞术(TAE)在重症急性胰腺炎(SAP)并发假性动脉瘤破裂出血中的应用价值。方法对13例SAP并发假性动脉瘤破裂出血患者行TAE,分析假性动脉瘤DSA表现及栓塞情况。结果 13例SAP患者共并发15个假性动脉瘤,包括感染性假性动脉瘤13个、腐蚀性假性动脉瘤2个。6个(6/15,40.00%)假性动脉瘤的责任动脉为脾动脉,5个(5/15,33.33%)为肠系膜上动脉,2个(2/15,13.33%)为胃十二指肠动脉,1个(1/15,6.67%)为肠系膜下动脉,1个(1/15,6.67%)为胃网膜右动脉(1/15,6.67%)。TAE治疗技术成功率为93.33%(14/15)。1例(1个假性动脉瘤)TAE术后出现脾脓肿,经穿刺引流及抗感染好转。感染性假性动脉瘤患者死亡率为45.45%(5/11),腐蚀性假性动脉瘤无死亡患者。TAE术后复发出血率为15.38%(2/13)。结论 TAE是治疗SAP并发假性动脉瘤破裂出血的有效方法。

Transcatheter arterial embolization in treatment of severe acute pancreatitis complicated with hemorrhagic pseudoaneurysm

Objective To investigate the value of transcatheter arterial embolizaiton (TAE) in treatment of severe acute pancreatitis (SAP) complicated with hemorrhagic pseudoaneurysm. Methods TAE was performed in 13 patients with SAP complicated with ruptured pseudoaneurysm. DSA findings and embolization of pseudoaneurysm were analyzed. Results There were 15 pseudoaneurysms in 13 patients, including 13 infective pseudoaneurysms and 2 corrosive pseudoaneurysms. The responsible arteries included splenic artery in 6 lesions (6/15, 40.00%), superior mesenteric artery in 5 lesions (5/15, 33.33%), gastroduodenal artery in 2 lesions (2/15, 13.33%), inferior mesenteric artery in 1 lesion (1/15, 6.67%) and right gastroomental artery in 1 case (1/15, 6.67%). The technical success rate of TAE was 93.33% (14/15). One case developed splenic abscess after TAE and was treated with puncture drainage and anti-infection measures. The mortality rate of patients with infective pseudoaneurysms was 45.45% (5/11). No death occurred in corrosive pseudoaneurysm patients. Recurrent bleeding rate after TAE was 15.38% (2/13). Conclusion TAE is an effective method for treatment of SAP complicated with ruptured pseudoaneurysm.