Wu Chia-Chien, Chen Huan-Wu, Lee Ker-En, Wong Yon-Cheong, Ku Yi-Kang
Department of Medical Imaging and Intervention, New Taipei Municipal Tu Cheng Hospital, Chang Gung Medical Foundation, New Taipei City 236, Taiwan.
Division of Emergency and Critical Care Radiology, Department of Medical Imaging & Intervention, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
J Pers Med. 2023 Jan 31;13(2):264. doi: 10.3390/jpm13020264.
Hemorrhage after pancreaticoduodenectomy is an uncommon but fatal complication. In this retrospective study, the different treatment modalities and outcomes for treating post-pancreaticoduodenectomy hemorrhage are analyzed.
Our hospital imaging database was queried to identify patients who had undergone pancreaticoduodenectomy during the period of 2004-2019. The patients were retrospectively split into three groups, according to their treatment: conservative treatment without embolization (group A: A1, negative angiography; A2, positive angiography), hepatic artery sacrifice/embolization (group B: B1, complete; B2, incomplete), and gastroduodenal artery (GDA) stump embolization (group C).
There were 24 patients who received angiography or transarterial embolization (TAE) treatment 37 times (cases). In group A, high re-bleeding rates (60%, 6/10 cases) were observed, with 50% (4/8 cases) for subgroup A1 and 100% (2/2 cases) for subgroup A2. In group B, the re-bleeding rates were lowest (21.1%, 4/19 cases) with 0% (0/16 cases) for subgroup B1 and 100% (4/4 cases) for subgroup B2. The rate of post-TAE complications (such as hepatic failure, infarct, and/or abscess) in group B was not low (35.3%, 6/16 patients), especially in patients with underlying liver disease, such as liver cirrhosis and post-hepatectomy (100% (3/3 patients), vs. 23.1% (3/13 patients); = 0.036, < 0.05). The highest rate of re-bleeding (62.5%, 5/8 cases) was observed for group C. There was a significant difference in the re-bleeding rates of subgroup B1 and group C ( = 0.00017). The more iterations of angiography, the higher the mortality rate (18.2% (2/11 patients), <3 times vs. 60% (3/5 patients), ≥3 times; = 0.245).
The complete sacrifice of the hepatic artery is an effective first-line treatment for pseudoaneurysm or for the rupture of the GDA stump after pancreaticoduodenectomy. Hepatic complications are not uncommon and are highly associated with underlying liver disease. Conservative treatment, the selective embolization of the GDA stump, and incomplete hepatic artery embolization do not provide enduring treatment effects.
胰十二指肠切除术后出血是一种罕见但致命的并发症。在这项回顾性研究中，分析了治疗胰十二指肠切除术后出血的不同治疗方式及结果。
查询我院影像数据库，以确定2004年至2019年期间接受胰十二指肠切除术的患者。根据治疗方式，将患者回顾性分为三组：未行栓塞的保守治疗（A组：A1，血管造影阴性；A2，血管造影阳性）、肝动脉牺牲/栓塞（B组：B1，完全性；B2，不完全性）以及胃十二指肠动脉（GDA）残端栓塞（C组）。
24例患者接受了血管造影或经动脉栓塞（TAE）治疗37次（例）。A组观察到高再出血率（60%，6/10例），A1亚组为50%（4/8例），A2亚组为100%（2/2例）。B组再出血率最低（21.1%，4/19例），B1亚组为0%（0/16例），B2亚组为100%（4/4例）。B组TAE后并发症（如肝衰竭、梗死和/或脓肿）发生率不低（35.3%，6/16例患者），尤其是在有潜在肝脏疾病的患者中，如肝硬化和肝切除术后患者（100%（3/3例患者），vs. 23.1%（3/13例患者）；P = 0.036，<0.05）。C组观察到最高的再出血率（62.5%，5/8例）。B1亚组和C组的再出血率有显著差异（P = 0.00017）。血管造影次数越多，死亡率越高（18.2%（2/11例患者），<3次 vs. 60%（3/5例患者），≥3次；P = 0.245）。
肝动脉完全牺牲是胰十二指肠切除术后假性动脉瘤或GDA残端破裂的有效一线治疗方法。肝脏并发症并不少见，且与潜在肝脏疾病高度相关。保守治疗、GDA残端选择性栓塞以及不完全肝动脉栓塞不能提供持久的治疗效果。
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