de Perrot M, Berney T, Bühler L, Delgadillo X, Mentha G, Morel P
Clinic of Digestive Surgery, Department of Surgery, University Hospital of Geneva, Switzerland.
Br J Surg. 1999 Jan;86(1):29-32. doi: 10.1046/j.1365-2168.1999.00983.x.
Bleeding pseudoaneurysm is a rare but frequently fatal complication in patients with pancreatitis.
The medical records of ten patients who presented to this institution with a bleeding pseudoaneurysm between 1978 and 1997 were reviewed retrospectively. Six patients had chronic pancreatitis and four had acute pancreatitis. The splenic artery was involved in six cases, a pancreaticoduodenal artery in two, the gastroduodenal artery in one and the cystic artery in one.
Computed tomography (CT) revealed the bleeding pseudoaneurysm in all patients (n = 6) with chronic pancreatitis but in only one of three with acute pancreatitis. Arteriography always gave the correct diagnosis. Seven patients underwent pancreatic resection as an emergency (n = 3) or within 48 h (n = 4), and survived. Three patients presenting with acute pancreatitis and massive bleeding underwent transcatheter arterial embolization. Two of them had a favourable outcome and one died from a recurrent haemorrhage 7 days later. Overall, two patients suffered significant perioperative complications and one died.
CT is accurate in the diagnosis of pseudoaneurysms complicating pseudocysts. Primary resection of the pseudoaneurysm, which frequently requires pancreatic resection, is the treatment of choice. Angiography followed by transcatheter embolization is effective, but should be rapidly followed by operation.
出血性假性动脉瘤是胰腺炎患者中一种罕见但常致命的并发症。
回顾性分析1978年至1997年间本院收治的10例出血性假性动脉瘤患者的病历。6例为慢性胰腺炎，4例为急性胰腺炎。脾动脉受累6例，胰十二指肠动脉2例，胃十二指肠动脉1例，胆囊动脉1例。
计算机断层扫描（CT）在所有慢性胰腺炎患者（n = 6）中均显示出出血性假性动脉瘤，但在3例急性胰腺炎患者中仅1例显示。血管造影总能做出正确诊断。7例患者作为急诊（n = 3）或在48小时内（n = 4）接受了胰腺切除术，并存活下来。3例急性胰腺炎并大出血患者接受了经导管动脉栓塞术。其中2例预后良好，1例在7天后死于再次出血。总体而言，2例患者出现严重的围手术期并发症，1例死亡。
CT对诊断假性囊肿合并假性动脉瘤准确。假性动脉瘤的一期切除常需行胰腺切除，是首选的治疗方法。血管造影后行经导管栓塞术有效，但应尽快继以手术治疗。
