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胆道术后假性动脉瘤破裂出血14例诊治分析

陈国度 孟翔飞 王敬 向昕

引用本文:
Citation:

胆道术后假性动脉瘤破裂出血14例诊治分析

详细信息
  • 中图分类号: R657.4

Diagnosis and treatment of hemobilia from ruptured false aneurysms after hepatobiliary surgery: An analysis of 14 cases

  • 摘要:

    目的探讨胆道术后假性动脉瘤破裂出血的诊治方法及预防。方法回顾性分析解放军总医院肝胆外科2002年1月至2012年3月收治的14例胆道术后假性动脉瘤破裂出血患者的临床资料。14例患者猝死4例,其余10例按不同诊断治疗方法分为3组:出血后保守治疗组2例;出血后立即行剖腹探查、止血术组5例;出血后立即行选择性数字减影血管造影(DSA)检查及介入栓塞(TAE)治疗组3例。对其诊治要点及预防措施进行探讨。结果本组病例死亡6例,治愈8例。保守治疗2例均失败(100%),后均接受DSA检查及TAE治疗,1例死亡;剖腹探查、止血5例,2例确诊(40%)后治愈(40%),余3例术后又接受DSA检查及TAE治疗,1例死亡;出血后立即行选择性DSA检查及TAE治疗组3例,确诊3例(100%),治愈3例(100%)。所有病例共行选择性DSA检查8例,确诊8例(100%),经TAE治疗9次(8例),有效8次(89%),治愈6例(75%);其中经2次TAE治疗1例,死亡2例。死亡病例中4例猝死,1例为2次TAE治疗后肝功能衰竭死亡,另1例为剖腹转栓塞止血后多脏器功能衰竭死亡。结论胆道术后假性动脉瘤破裂出血应早期诊...

     

  • [1]Li XG, Zhang XB, Shi HF, et al.Imaging Diagnosis and transcath-eter arterial embolization for massive hemorrhage due to pseudoaneu-rysms complicating pancreatitis[J].Med J Peking Union Med Col-lege Hosp, 2010, 1 (1) :77-81. (in Chinese) 李晓光, 张晓波, 金征宇, 等.胰腺炎并发假性动脉瘤大出血的影像诊断及其经导管动脉栓塞治疗[J].协和医学杂志, 2010, 1 (1) :77-81.
    [2]Kriwanek S, Gschwantler M, Beckerhinn P, et al.Complication-safter surgery for necrotising pancreatitis:risk factors and prognosis[J].Eur J Surg, 1999, 165 (7) :952-957.
    [3]Beattie GC, Hardman JG, R edhead D, et al.Evidence for a cen-tralrole for selective mesenteric angiography in the management ofthe major vascular complications of pancreatitis[J].Am J Surg, 2003, 185 (19) :96.
    [4]Shibata T, Sagoh T, Ametani F, et al.Transcatheter microcoil em-bolotherapy for ruptured pseudo aneurysm following pancreatic andbiliary surgery[J].Cardiovasc Intervent Radiol, 2002, 25 (21) :180.
    [5]Tessier DJ, Fowl RJ, Stone WM, et al.Iatrogenic Hepatic arterypseudoaneurysms:an uncommon complication afterhepatic, biliary, andpancreatic procedures[J].Ann Vasc Surg, 2003, 17 (31) :663-669.
    [6] Huang JF.Surgery of the Liver, Biliary Tract and Pancreas[M].Beijing:People's Medical Publishing House, 2010:1050, 1065. (in Chinese) 黄洁夫.肝胆胰外科学[M].北京:人民卫生出版社, 2010:1050, 1065.
    [7]Kassasseye A, Ziyani F, Roffet F.Hemohilia after laparoscopic cys-tectomy apropos of a case.Review of the literature[J].Ann Chir, 1997, 51:159.
    [8]Zhang JX, Chen XR.Pseudoaneurysm of hepatic artery and cysticartery after laparoscopic cholecystectomy[J].Chin J HepatobiliarySurg, 2004, 10 (7) :498. (in Chinese) 张吉祥, 陈训如.腹腔镜胆囊切除术后肝动脉与胆囊动脉假性动脉瘤[J].中华肝胆外科杂志, 2004, 10 (7) :498.
    [9]Li N, Li Y, Qin MF, et al.A case with hemobilia from rupturedfalse aneurysms following laparoscopic choledochotomy[J].Chin JDig Endosc, 2004, 21 (1) :35. (in Chinese) 李宁, 李湧, 秦明放.腹腔镜胆道探查术后假性动脉瘤并发胆道出血一例[J].中华消化内镜杂志, 2004, 21 (1) :35.
    [10]Huang ZQ, Huang XQ, Song Q.Operative Surgery of the BiliaryTract[M].Beijing:People's Military Medical Publisher, 2010:55, 316. (in Chinese) 黄志强, 黄晓强, 宋青.黄志强胆道外科手术学[M].北京:人民军医出版社, 2010:55, 316.
    [11]Lu JL, Li JY, Xu LY, et al.A case with hepatic artery bleeding af-ter PTCD[J].J Clin Hepatol, 2011, 27 (7) :755. (in Chinese) 路军良, 李京雨, 徐力扬, 等.经皮穿刺胆道引流术治疗肝动脉损伤大出血1例[J].临床肝胆病杂志, 2011, 27 (7) :755.
    [12]Yoon YS, Kim SW, Her KH, et al.Management of postoperativehemorrhage after pancrea toduodenectomy[J].Hepatogastroenterol-ogy, 2003, 50 (54) :2208-2212.
    [13]Emre F, Yekebas MD, Lars Wolfram, et al.Postpancreatotomyhemorrhage:diagnosisand treatment-an analysis in 1669 consecu-tive pancreati resections[J].Ann Surg, 2007, 246 (2) :269-280.
    [14] Dong JH.Biliary Surgery:Highlights and Blind Spots[M].Bei-jing:People's Medical Publishing House, 2010:271, 353, 430, 432. (in Chinese) 董家鸿.要点与盲点:胆道外科[M].北京:人民卫生出版社, 2010:271, 353, 430, 432.
    [15]Huang H, Song GD, Zhang CJ, et al.Three cases with cystic arterypseudoaneurysm following laparoscopic cholecystectomy[J].Chin JPract Surg, 2001, 21 (10) :629. (in Chinese) 黄辉, 宋根达, 张纯俊, 等.腹腔镜胆囊切除术致胆囊假性动脉瘤3例报告[J].中华实用外科杂志, 2001, 21 (10) :629.
    [16]Li SW, Liu CA, Wu CX.A case of bleeding with ruptured cysticartery pseudoaneurysm following laparoscopic cholecystectomy[J].Chin J Gen Surg, 2003, 18 (5) :30. (in Chinese) 李生伟, 刘长安, 吴传新.腹腔镜胆囊切除术后胆囊动脉假性动脉瘤自发破裂大出血一例[J].中华普通外科杂志, 2003, 18 (5) :30.
    [17]Rivitz SM, Waltman AC, Kelsey PB.Embo lization of hepatic ar-tery pseudoaneurysm following laparoscopic cholecystectomy[J].Cardiovasc Intervent Radiol, 1996, 19 (4) :43.
    [18]Lu JL, Li JY, Zhang Q, et al.Interventional treatment of visceral an-eurysms:an investigation of therapeutic technique[J].J Intervent Ra-diol, 2009, 18 (2) :90-92. (in Chinese) 路军良, 李金雨, 张强, 等.腹腔内脏血管动脉瘤的介入治疗方法探讨[J].介入放射学杂志, 2009, 18 (2) :90-92.
    [19]You J, Mou W, Chen W, et al.Imaging diagnosis and interventionaltreatment of pseudoaneurysm[J].Acta Academiae Med Militaris Ter-tiae, 2002, 24 (6) :648-650. (in Chinese) 游箭, 牟玮, 陈伟, 等.假性动脉瘤的影像诊断及介入治疗[J].第三军医大学学报, 2002, 24 (6) :648-650.
    [20]Savader SJ, Trerotola SO, Merine DS, et al.Hemobilia after percu-taneous transhepatic biliary drainage:treatment with transcatheterembolotherapy[J].J Vasc Interv Radiol, 1992, 3 (5) :345-352.
    [21]Eurvilaichit C.Iatrogenic hemobilia:management with transarterial em-bolization using gelfoam particles[J].J Med Assoc Thai, 1999, 82 (2) :931-937.
    [22] Shibata T, Sagoh T, Ametani F, et al.Transcatheter microcoil em-bolotherapy for ruptured pseudoaneurysm following pancreatic andbiliary surgery[J].Cardiovasc Intervent Radiol, 2002, 25 (4) :180-185.
    [23]Reber PU, Baer HU, Patel AC, et al.Superselective microcoil em-bol izalion:treatment of choice in high risk patients with extrahepat-ic pseudoaneurysms of the hepatic arteries[J].J Am Coll Surg, 1998, 186 (7) :325.
    [24]Tessier DJ, Stone WM, Fowl RJ, et al.Clinical features and man-agement of splenic artery pseudoaneurysm:case series and cumula-tive review of literature[J].J Vasc Surg, 2003, 38 (11) :969.
    [25]Li JP.Clinical analysis on early-stage abdominal reoperation:areport of 28 cases[J].Modern Med Health, 2005, 21 (23) :3273. (in Chinese) 李建平.腹部手术后早期再手术28例分析[J].现代医药卫生, 2005, 21 (23) :3273.
    [26] Cheng RC, Liu QY.Whether preventive drainage is needed or notafter abdominal surgery[J].Chin J Dig Surg, 2008, 7 (5) :326. (in Chinese) 程若川, 刘其雨.腹部手术后是否需要预防引流[J].中华消化外科杂志, 2008, 7 (5) :326.
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