CAJ | 학술논문

目的：评价介入治疗技术治疗胰腺疾病外科术后大出血的安全性和有效性。方法对20例胰腺疾病外科术后大出血患者进行介入治疗，单纯血管内栓塞术18例，联合内支架植入术1例，联合肠系膜上动脉局部灌注1例。栓塞材料用微型钢丝圈14例，普通钢丝圈2例，同时用聚乙烯醇微球6例，同时用明胶海绵4例。结果栓塞前选择性血管造影显示，单纯假性动脉瘤形成13例，合并对比剂外溢3例，单纯对比剂外溢3例，血管造影阴性1例。介入治疗止血成功率90%（18/20），20例中2例于次日因应激性溃疡大出血死亡。18例首次介入止血成功者有2例再发出血，再出血率11.1%（2/18）。18例介入治疗成功者，术后经输血、补液等对症处理后，生命体征平稳，引流管及胃管引流液血性液体消失。随访中，原有合并胰瘘、腹腔脓肿者2例因大出血、失血性休克而死亡，其余16例随访2周至24个月过程中，未再出现大出血。4例行肝固有动脉栓塞者介入术后谷丙转氨酶出现一过性升高，其他患者未出现肠坏死、胰腺坏死、脾脓肿表现。结论血管内介入治疗是治疗胰腺疾病外科术后大出血的安全有效方法。
목적：평개개입치료기술치료이선질병외과술후대출혈적안전성화유효성。방법대20례이선질병외과술후대출혈환자진행개입치료，단순혈관내전새술18례，연합내지가식입술1례，연합장계막상동맥국부관주1례。전새재료용미형강사권14례，보통강사권2례，동시용취을희순미구6례，동시용명효해면4례。결과전새전선택성혈관조영현시，단순가성동맥류형성13례，합병대비제외일3례，단순대비제외일3례，혈관조영음성1례。개입치료지혈성공솔90%（18/20），20례중2례우차일인응격성궤양대출혈사망。18례수차개입지혈성공자유2례재발출혈，재출혈솔11.1%（2/18）。18례개입치료성공자，술후경수혈、보액등대증처리후，생명체정평은，인류관급위관인류액혈성액체소실。수방중，원유합병이루、복강농종자2례인대출혈、실혈성휴극이사망，기여16례수방2주지24개월과정중，미재출현대출혈。4례행간고유동맥전새자개입술후곡병전안매출현일과성승고，기타환자미출현장배사、이선배사、비농종표현。결론혈관내개입치료시치료이선질병외과술후대출혈적안전유효방법。
Objective To evaluate the efficacy and safety of the interventional techniques for treatment of postoperative massive hemorrhage on pancreatic diseases. Methods Twenty patients with postoperative hemorrhage were treated with endovascular interventional techniques, and 18 of whom with only superselective arterial embolization, 1 of whom combined with stent placement and one combined with regional perfusion through SMA approach. The embolization devices were microcoils in 14 cases and standard stainless steel coils in 2 cases, associated with polyvinyl alcohol particles (PVA) in 6 cases and with gelfoams in 4 cases. Results Selective angiogram revealed the pseudoaneurysm in 13 cases, contrast media extravasation in 3 cases, pseudo aneurysm combined with contrast media extravasation in 3 cases. The technical success rate was 90%(18/20), and 2 died of massive hemorrhage associated with stress ulcer. Recurrent bleeding rate was 11.1%(2/18). Angiography demonstrated complete obliteration of relative vessels after embolization, and patency with stable blood lfow of the hepatic artery after stent placement,18 patients with hemodynamically compromise experienced immediate relief of their blood loss related symptoms. Two patients with pancreatic ifstula and intra-abdominal abscess recurred bleeding in two weeks and died of hemorrhagic shock. The other 16 patents didn’t occur bleeding in the following 2 weeks to 24 months. ALT occurred temporary increase in 4 patients with proper hepatic arterial embolization. Other complications, such as intestinal and pancreatic necrosis were not cbserved. Conclusion Transcatheter endovascular techniques are safe and effective to treat postoperative massive hemorrhage on pancreatic diseases.