Chair of Hospital Surgery, Belgorod State University, Belgorod, Russian Federation.
Interventional Radiologist, Department of Interventional Radiology, Arkhangelsk Regional Clinical Hospital, Arkhangelsk, Russian Federation.
Arch Razi Inst. 2022 Feb 28;77(1):375-381. doi: 10.22092/ARI.2021.356560.1871. eCollection 2022 Feb.
Pancreatic hemorrhage is one of the most severe complications of various pancreatic diseases that are difficult to treat even in multidisciplinary hospitals. Mortality from pancreatic hemorrhage can reach up to 80%. This study aimed to evaluate the possibility of maintaining endovascular homeostasis in the treatment of patients with pancreatic hemorrhage. This retrospective multicenter study included 45 patients (33 men and 12 women) in the age range of 27-84 years. More than 50% (n=23) of the patients were diagnosed with chronic pancreatitis. Malignant pancreatic lesions were observed in 22 patients; of whom11 patients had acute necrotizing pancreatitis. Acute bleeding was observed in 39 (86.6%) patients, and 6 (13.3%) patients showed chronic symptoms. Single-shot and recurrent bleeding was recorded in 22(48.9%) and 23 (51.1%) patients. In total, 57 patients underwent endovascular surgery. Moreover, 45 patients underwent primary surgery and another 12 (2.2%) underwent reoperation due to recurrent bleeding. Intraoperative complications occurred in 1 (2.2%) patient, and postoperative complications occurred in another. Out of all 45 patients, seven patients had 15 episodes of recurrent bleeding, of whom four patients showed recurrent bleeding at the in-hospital period, and the other three were under local supervision after the previous endovascular intervention. Out of the 45 patients, 35 (77.7%) survived and another 10 (22.2%) died due to multiple organ failure (n=8) and recurrent bleeding and hemorrhagic shock (n=2). Out of 10 patients who died, 4, 3, and 3patients showed malignant pancreatic lesions after surgery, acute pancreatitis, and chronic pancreatitis, respectively. Endovascular hemostatic interventions can significantly increase the survival rate in severe groups of patients with pancreatic bleeding. Endovascular hemostasis is a safe procedure and may be called the "method of choice" in the treatment of pancreatic bleeding, especially in combination with percutaneous draining, aspiration, and injection of liquid embolic agents into leakage of pancreatic juice.
胰腺出血是各种胰腺疾病中最严重的并发症之一，即使在多学科医院也难以治疗。胰腺出血的死亡率可高达 80%。本研究旨在评估维持血管内平衡在治疗胰腺出血患者中的可能性。本回顾性多中心研究纳入了 45 名年龄在 27-84 岁之间的患者（33 名男性和 12 名女性）。超过 50%（n=23）的患者被诊断为慢性胰腺炎。22 名患者存在恶性胰腺病变；其中 11 名患者患有急性坏死性胰腺炎。39 名（86.6%）患者表现为急性出血，6 名（13.3%）患者表现为慢性症状。22 名（48.9%）和 23 名（51.1%）患者分别记录到单次出血和复发性出血。共有 57 名患者接受了血管内手术。此外，45 名患者接受了初次手术，另外 12 名（2.2%）患者因复发性出血而接受了再次手术。1 名（2.2%）患者发生术中并发症，另 1 名患者发生术后并发症。在所有 45 名患者中，7 名患者出现了 15 次复发性出血，其中 4 名患者在住院期间出现复发性出血，另外 3 名患者在先前的血管内干预后接受了局部监测。在 45 名患者中，35 名（77.7%）存活，10 名（22.2%）因多器官衰竭（n=8）和复发性出血和出血性休克（n=2）死亡。在 10 名死亡患者中，术后分别有 4、3 和 3 名患者显示恶性胰腺病变、急性胰腺炎和慢性胰腺炎。血管内止血干预可显著提高严重胰腺出血患者的生存率。血管内止血是一种安全的操作，可能被称为胰腺出血治疗的“首选方法”，特别是与经皮引流、抽吸和向胰液漏出部位注射液体栓塞剂相结合时。
