Li Xiaoye, Xia Shibo, Yuan Liangxi, Zhang Lei, Song Chao, Wei Xiaolong, Lu Qingsheng
Department of General Surgery, No. 929 Hospital, Naval Medical University, Shanghai, 200433, China.
Vascular Surgery, Department of General Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
Chin J Traumatol. 2025 Jan;28(1):7-12. doi: 10.1016/j.cjtee.2024.08.009. Epub 2024 Oct 29.
Postpancreatectomy hemorrhage (PPH) is a life-threatening complication after pancreatoduodenectomy. Stent-graft implantation is an emerging treatment option for PPH. This study reports the outcome of PPH treated with stent-graft implantation.
This was a single-center, retrospective study. Between April 2020 and December 2023, 1723 pancreatectomy cases were collected while we screened 12 cases of PPH after pancreatoduodenectomy treated with stent-graft implantation. Patients' medical and radiologic images were retrospectively reviewed. Technical and clinical success, complications, and stent-graft patency were evaluated. Continuous data are reported as means ± standard deviation when normally distributed or as median (Q, Q) when the data is non-normal distributed. Categorical data are reported as n (%). A p < 0.05 was considered statistically significant. Kaplan-Meier estimates were used for stent patency and patients' survival.
Pancreatic fistula was identified in 6 cases (50.0%), and pseudoaneurysm was identified in 3 cases (25.0%), including pancreatic fistula together with pseudoaneurysm in 1 case (8.3%). All pseudoaneurysm or contrast extravasation sites were successfully excluded with patent distal perfusion, thus technical success was achieved in all cases. The overall survival rate at 6 months and 1 year was 91.7% and 78.6%, respectively. One patient had herniation of the small intestine into the thoracic cavity, which caused a broad thoracic and abdominal infection and died during hospitalization. Rebleeding occurred at the gastroduodenal artery stump in 1 case after stent-graft implantation for the splenic artery and was successfully treated with another stent-graft implantation. Two cases of asymptomatic stent-graft occlusion were observed at 24.6 and 26.3 after the operation, respectively.
With suitable anatomy, covered stent-graft implantation is an effective and safe treatment option for PPH with various bleeding sites and causes.
胰十二指肠切除术后出血（PPH）是一种危及生命的并发症。支架移植物植入是PPH的一种新兴治疗选择。本研究报告了支架移植物植入治疗PPH的结果。
这是一项单中心回顾性研究。在2020年4月至2023年12月期间，收集了1723例胰腺切除病例，同时筛选出12例接受支架移植物植入治疗的胰十二指肠切除术后PPH病例。对患者的医学和影像学图像进行回顾性分析。评估技术和临床成功率、并发症及支架移植物通畅情况。连续数据在正态分布时以均值±标准差报告，非正态分布时以中位数（Q1，Q3）报告。分类数据以n（%）报告。p<0.05被认为具有统计学意义。采用Kaplan-Meier法评估支架通畅率和患者生存率。
6例（50.0%）发现胰瘘，3例（25.0%）发现假性动脉瘤，其中1例（8.3%）同时存在胰瘘和假性动脉瘤。所有假性动脉瘤或造影剂外渗部位均通过远端灌注通畅成功排除，所有病例均取得技术成功。6个月和1年的总生存率分别为91.7%和78.6%。1例患者小肠疝入胸腔，导致广泛的胸腹部感染，住院期间死亡。1例脾动脉支架移植物植入术后胃十二指肠动脉残端再次出血，再次植入支架移植物成功治疗。术后分别于24.6和26.3个月观察到2例无症状支架移植物闭塞。
在合适的解剖条件下，覆膜支架移植物植入是治疗不同出血部位和病因的PPH的有效且安全的治疗选择。
