胰腺炎和胰腺手术后内脏动脉侵蚀的开放手术和血管内治疗选择的评估。

Evaluation of Open Surgical and Endovascular Treatment Options for Visceral Artery Erosions after Pancreatitis and Pancreatic Surgery.

机构信息

Department of Vascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany.

Department of Radiology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany.

出版信息

Curr Oncol. 2022 Mar 30;29(4):2472-2482. doi: 10.3390/curroncol29040201.

DOI:10.3390/curroncol29040201

PMID:35448175

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9025466/

Abstract

PURPOSE

To report and compare the results of endovascular and open surgical treatment for erosion bleeding of visceral arteries following pancreatitis and pancreatic surgery.

MATERIALS AND METHODS

This retrospective study included 65 consecutive patients (46 males, mean age 63 ± 14 years) presenting with visceral artery erosions between January 2011 and December 2020. Endpoints were technical success, freedom from reintervention, stent-graft-related complications, and 30-day and one-year mortality.

RESULTS

The causes of erosion bleeding included complications of surgical treatment for the pancreas and upper gastrointestinal tract (75%), pancreatitis (19%), and spontaneous bleeding (6%). Pancreatectomy was performed in 34 (52%) patients, representing 2% of all pancreatectomy procedures ( = 1645) performed in our hospital during the study period. A total of 37 (57%) patients underwent endovascular treatment (EVT), and 28 (43%) patients had open surgery (OS) as a primary treatment. Eight of 37 (22%) patients in the EVT group underwent stent-graft treatment of the eroded vessels and 28 (78%) coil embolization. Six (9%) patients underwent reintervention with no significant differences between EVT and OS groups (11% vs. 7%, = 0.692). Postoperative morbidity and complications in 52% of all patients were higher in the OS group than in the EVT group (41% vs. 68%, = 0.029). The in-hospital 30-days mortality rate for all patients was 25%, and it was higher in the OS group than in the EVT group (14% vs. 39%, = 0.017).

CONCLUSIONS

An endovascular-first strategy for treating visceral arteries erosions may be preferred to reduce the complications associated with open surgery if patients are hemodynamically stable and have no anastomotic insufficiency. Endovascular treatment may be associated with better in-hospital survival when compared to primary open surgery. Further studies are required to identify the optimal approach.

摘要

目的

报告并比较胰腺炎和胰腺手术后内脏动脉侵蚀性出血的血管内和开放手术治疗结果。

材料和方法

本回顾性研究纳入了 2011 年 1 月至 2020 年 12 月期间连续 65 例（男 46 例，平均年龄 63 ± 14 岁）内脏动脉侵蚀患者。终点为技术成功率、免于再次干预、支架移植物相关并发症、30 天和 1 年死亡率。

结果

侵蚀性出血的原因包括胰腺和上消化道手术并发症（75%）、胰腺炎（19%）和自发性出血（6%）。34 例（52%）患者行胰腺切除术，占研究期间我院所有胰腺切除术的 2%（=1645 例）。37 例（57%）患者行血管内治疗（EVT），28 例（43%）患者行开放性手术（OS）作为主要治疗方法。EVT 组 8 例（22%）患者行侵蚀血管支架治疗，28 例（78%）行线圈栓塞。EVT 和 OS 组的再干预率无显著差异（11%vs.7%，=0.692）。所有患者中，52%发生术后并发症，OS 组发生率高于 EVT 组（41%vs.68%，=0.029）。所有患者住院 30 天死亡率为 25%，OS 组高于 EVT 组（14%vs.39%，=0.017）。