摘要
目的探讨急症血管内栓塞治疗重症急性胰腺炎(SAP)并发出血的临床价值。方法收集2010年至2016年收治的71例SAP患者临床资料,均接受急症DSA造影。其中27例(38.0%)患者接受血管内栓塞治疗。分析所有患者DSA造影表现及27例血管内栓塞结果。结果动脉造影发现20例(28.2%,20/71)患者动脉破裂出血,7例(9.9%,7/71)假性动脉瘤,共32支责任动脉中11支脾动脉(34.4%,11/32)为主要出血动脉。32次血管内栓塞成功率为93.8%(30/32)。术后栓塞并发症4例,其中2例患者脾梗死,对症治疗后好转,1例肝脓肿和1例脾脓肿,经抗感染及置管引流好转;死亡3例,其中2例因失血性休克,1例因脑干梗死,均与介入操作无关。5例(25%,5/20)复发出血(其中4例出血点不同于初次出血点),二次栓塞均成功止血。结论血管内造影栓塞可及时发现SAP并发出血患者责任动脉,达到快速止血目的。
Objective To investigate the clinical value of endovascular embolization in treating severe acute pancreatitis(SAP)associated with hemorrhage.Methods The clinical data of 71 patients with SAP,who were admitted to authors’hospital during the period from 2010 to 2016,were collected.DSA was performed in all patients.Of the 71 patients,27(38.0%)received endovascular embolization treatment.The angiographic findings and the endovascular embolization results of the 27 patients were analyzed.Results Angiography demonstrated that 20 patients(28.2%,20/71)had hemorrhage due to arterial rupture and 7 patients(9.9%,7/71)had pseudoaneurysm formation.A total of 32 responsible arteries were detected,and the spleen artery was the main bleeding artery(34.4%,11/32).A total of 32 endovascular embolization procedures were carried out,the technical success rate was 93.8%(30/32).Post-embolization complication was seen in 4 patients,including infarction of spleen(n=2),which was improved after symptomatic treatment,liver abscess(n=1)and splenic abscess(n=1),which were improved after anti-infection therapy and tube drainage.Three patients died of hemorrhagic shock(n=2)or brain stem infarction(n=1),the causes of death were not related to the intervention operation.Five patients developed recurrent hemorrhage,in 4 of them the new bleeding point was different from the primary bleeding point,and successful hemostasis was achieved after second embolization treatment.Conclusion In treating SAP associated with hemorrhage,angiography together with endovascular embolization can quickly detect the hemorrhagic responsible arteries,thus,rapid hemostasis can be reliably achieved.
作者
艾敏
刘丽
卢光明
许健
AI Min;LIU Li;LU Guangming;XU Jian(Department of Medical Imaging,Affiliated Jinling Hospital ,School of Medicine ,Nanjing University,Nanjing,Jiangsu Province 210002,China)
出处
《介入放射学杂志》
CSCD
北大核心
2019年第3期276-279,共4页
Journal of Interventional Radiology
关键词
出血
血管内栓塞
重症急性胰腺炎
hemorrhage
endovascular embolization
severe acute pancreatitis
