Ai Min, Lu GuangMing, Xu Jian
Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu Province, China.
Wideochir Inne Tech Maloinwazyjne. 2019 Sep;14(3):401-407. doi: 10.5114/wiitm.2019.86919. Epub 2019 Jul 25.
Severe acute pancreatitis (SAP) has a high mortality rate of 20% to 30%, with death often resulting from hemorrhage.
To investigate the role of digital subtraction angiography (DSA) and endovascular embolization in the management of arterial bleeding in SAP patients.
Seventy-six patients with SAP admitted to our hospital between January 2010 and May 2016 underwent DSA. DSA revealed arterial bleeding in 22 of these patients, who were treated with transcatheter endovascular embolization with coils and/or gelfoam particles. Patient demographics, angiographic features of vascular abnormalities, and outcomes of embolization were assessed.
Arterial bleeding was the most common vascular abnormality (22/76 patients; 28.9%). DSA enabled the identification of 27 bleeding arteries in 22 patients. The splenic artery was the most commonly affected vessel (11/27; 40.7%). Among the 27 arteries treated with endovascular embolization, successful hemostasis was achieved in 96.3% (26/27). Two patients developed major complications (hepatic and splenic abscess). These patients were treated with abdominal catheter drainage and anti-infection measures and ultimately recovered. The mean interval between initial onset of SAP and angiographic diagnosis of arterial bleeding was 56 days. Rebleeding was diagnosed in 5 patients (5/22; 22.7%) during repeat angiography, with bleeding from new sites in four of these patients. The mean interval between successive angiography treatments was 38 days.
Endovascular embolization is a safe and effective method to localize bleeding arteries and achieve complete hemostasis in patients with SAP-related arterial bleeding.
重症急性胰腺炎（SAP）的死亡率高达20%至30%，死亡原因通常是出血。
探讨数字减影血管造影（DSA）及血管内栓塞术在SAP患者动脉出血治疗中的作用。
2010年1月至2016年5月期间我院收治的76例SAP患者接受了DSA检查。其中22例患者DSA显示存在动脉出血，这些患者接受了经导管血管内栓塞术，使用弹簧圈和/或明胶海绵颗粒进行治疗。评估了患者的人口统计学特征、血管异常的血管造影特征以及栓塞治疗的结果。
动脉出血是最常见的血管异常（22/76例患者；28.9%）。DSA能够识别22例患者中的27条出血动脉。脾动脉是最常受累的血管（11/27；40.7%）。在接受血管内栓塞治疗的27条动脉中，96.3%（26/27）实现了成功止血。2例患者出现严重并发症（肝脓肿和脾脓肿）。这些患者接受了腹腔置管引流和抗感染措施治疗，最终康复。SAP发病至动脉出血血管造影诊断的平均间隔时间为56天。5例患者（5/22；22.7%）在重复血管造影时被诊断为再次出血，其中4例患者出血来自新部位。连续血管造影治疗的平均间隔时间为38天。
血管内栓塞术是一种安全有效的方法，可定位SAP相关动脉出血患者的出血动脉并实现完全止血。
