腹部手术后腹腔干分支假性动脉瘤消化道瘘的临床分析：附5例分析

目的:总结分析腹部手术后腹腔干分支假性动脉瘤消化道瘘导致的迟发性消化道大出血的诊断和治疗。方法:回顾性分析自2013年1月—2014年9月腹部肿瘤术后上消化道大出血经造影证实腹腔干分支假性动脉瘤消化道瘘的5例患者的临床资料。结果:5例患者消化道出血时间平均为术后53.6 d;假性动脉瘤位于脾动脉2例,位于肝总动脉2例,位于左肝动脉1例;造影后行栓塞治疗4例,行覆膜支架置入1例。无术后严重并发症及围手术死亡病例。随访时间6~16个月,无再次假性动脉瘤破裂出血,肝总动脉覆膜支架置入患者于8个月猝死,原因未明。结论:腹腔干分支假性动脉瘤消化道瘘是腹部手术后罕见而又致命的并发症,应提高该病的认识,其诊断及治疗首选动脉造影及血管腔内治疗,避免医源性损伤可能是减少该病发生的关键。

Clinical analysis of fistula between pseudoaneurysm of celiac trunk branches and digestive tract after abdominal surgery: a report of 5 cases

Objective: To present and analyze the diagnosis and treatment of the delayed massive gastrointestinal hemorrhage caused by fistula formation between pseudoaneurysm of the celiac trunk branches and digestive tract following abdominal surgery. Methods: The clinical data of 5 patients from January 2013 to September 2014 who developed massive gastrointestinal hemorrhage after abdominal tumor surgery and were identified as fistula formation between pseudoaneurysm of the branches and digestive tract by angiography were analyzed. Results: Of the 5 patients, the average time to postoperative gastrointeatinal hemorrhage was 53.6 d; the pseudoaneurysm was located in the splenic artery in 2 cases, in the common hepatic artery in 2 cases and in the left hepatic artery in one case; 4 cases underwent embolization therapy after angiography, and one case underwent covered stent implantation. No severe postoperative complications or perioperative death occurred. Postoperative follow-up was conducted for 6 to 16 months, during which time, no rupture and hemorrhage of the pseudoaneurysm occurred, but there was sudden death of unknown cause in one case who had undergone common hepatic artery covered stent implantation. Conclusion: The fistula between pseudoaneurysm of celiac axis branches and digestive tract is a rare but fatal complication after abdominal surgery and its awareness should be enhanced. Angiography and endovascular repair are preferred for its diagnosis and treatment, and avoidance of iatrogenic injury may be critical for reducing the incidence of this condition.