胰十二指肠切除术后晚期出血的介入治疗

目的 评价介入治疗胰十二指肠切除术后晚期出血的有效性及安全性.方法 2004年8月至2009年3月对解放军总医院18例胰十二指肠切除术后晚期出血的患者行介入治疗,其中男14例、女4例,年龄23～75岁,胰腺癌8例,胰腺囊腺瘤2例,十二指肠乳头癌4例,胰腺炎4例.所用介入治疗方法 包括脾动脉栓塞、胃十二指肠动脉残端栓塞、肝动脉栓塞、经导管肠系膜上动脉分支血管加压素灌注、肝动脉覆膜支架置入.结果 所有患者共行介入治疗29次,16例患者末次介入治疗后均未再发出血,其余2例患者血管造影未发现明确出血征象亦未行假定出血血管栓塞治疗,再次开腹后证实为消化道溃疡出血,经手术切除溃疡部位后未再发出血.18例患者生存时间为1周～50个月,其中5例患者末次介入治疗后1～7周内死于感染、多器官功能衰竭,7例患者8～17个月后死于肿瘤进展,其余患者均健在.结论 介入治疗胰十二指肠切除术后晚期出血是安全、有效的,介入治疗应作为内科治疗无效的胰十二指肠切除术后晚期出血的首选治疗方法 .

Interventional radiology treatment for delayed pancreaticoduodenectomy hemorrhage

Objective To evaluate the efficacy and safety of interventional radiology in the treatment for delayed hemorrhage post-pancreaticoduodenecomy. Methods From August 2004 to March 2009, interventional radiology treatments were offered in 18 cases of delayed hemorrhage postpancreaticoduodenecomy. The patients consisted of 14 males and 4 females with an age range of 23-75 years old. There were pancreas carcinoma (n = 8) , cystadenoma of pancreas (n =2) , Vater's papilla carcinoma (n = 4) and pancreatitis (n = 4) . The interventional radiology treatments included the embolization of splenic artery, the embolization of stump of gastroduodenal artery, the embolization of hepatic artery, transcatheter infusion of vasopressin in the branches of superior mesenteric artery and cover stent placement in hepatic artery. Results A total of 29 interventional procedures were performed in 18 patients. Hemorrhage was ceased in 16 cases after interventional radiology treatment, no active bleeding was demonstrated and no embolization of assumed site of hemorrhage was performed in 2 cases after diagnostic angiography. Surgery was performed and hemorrhage ceased post-operatively. The average survival time of 18 cases was 18 months (range: 1 week - 50 months). Conclusion Interventional radiology treatment can be safely and effectively performed in the cases of delayed hemorrhage post-pancreaticoduodenecomy. It should be the first-choice therapy for this medically refractory condition.