Waltman A C, Luers P R, Athanasoulis C A, Warshaw A L
Arch Surg. 1986 Apr;121(4):439-43. doi: 10.1001/archsurg.1986.01400040077012.
Massive arterial hemorrhage from multiple sites caused by tissue injury and infection following severe pancreatitis occurred in 12 patients, who were treated with the combination of angiographic embolization techniques and surgery; five survived. Complete hemostasis was obtained in eight of 12 patients who underwent primary angiographic therapy. Bleeding was temporarily controlled in two patients, who then underwent directed surgical ligation of the bleeding vessel under more favorable conditions. In two patients, bleeding was not controlled. The use of permanent occluding materials, particularly bucrylate, resulted in the highest success rate. When the bleeding artery could not be individually catheterized for safe occlusion, balloon occlusion or vasopressin infusion stabilized the patient's condition, with a decrease in the rate of bleeding prior to subsequent surgical therapy. Inadequate control of further tissue necrosis and sepsis was the cause of death in five of the seven patients who died. The other two patients died of recurrent hemorrhage despite attempts at both arteriographic occlusion and surgical ligation.
12例重症胰腺炎后因组织损伤和感染导致多处大量动脉出血的患者接受了血管造影栓塞技术与手术联合治疗，其中5例存活。接受初次血管造影治疗的12例患者中有8例实现了完全止血。2例患者出血得到临时控制，随后在更有利的条件下对出血血管进行了直接手术结扎。2例患者出血未能得到控制。使用永久性闭塞材料，尤其是丁酯，成功率最高。当无法单独对出血动脉进行导管插入以安全闭塞时，球囊闭塞或血管加压素输注可稳定患者病情，使后续手术治疗前的出血率降低。7例死亡患者中有5例死于对进一步组织坏死和脓毒症控制不足。另外2例患者尽管尝试了动脉造影闭塞和手术结扎，但仍死于复发性出血。
