Bender J S, Bouwman D L, Levison M A, Weaver D W
Department of Surgery, Wayne State University, Detroit, Michigan, USA.
Pancreas. 1995 Mar;10(2):143-7. doi: 10.1097/00006676-199503000-00006.
Eight patients over an 8-year period required operation for spontaneous hemorrhage as a complication of a pancreatic pseudocyst. Three patients presented with abdominal pain or jaundice and bled in hospital while undergoing work-up. Four patients were admitted with upper gastrointestinal bleeding and one with intraperitoneal bleeding. Five patients were managed by pancreatic resection (two of the head and three of the tail) and three were managed by arterial ligation and internal drainage. There was one death (mortality rate, 12.5%). The first four patients in the series had their operations delayed secondary to a perceived need for further work-up or an inability to make an exact diagnosis of the bleeding site. All rebled, necessitating an emergency operation. The last four patients underwent an expedited workup and operation. Successful treatment of bleeding pancreatic pseudocysts requires good surgical judgment, especially when nonoperative methods fail or aren't applicable. The risk of recurrent hemorrhage is high, suggesting the need for immediate intervention once the diagnosis is made. Resection provides definitive control, although selected patients with easily accessible vessels may be managed more conservatively with ligation and drainage.
在8年期间，有8例患者因胰腺假性囊肿的并发症——自发性出血而需要进行手术。3例患者在接受检查时出现腹痛或黄疸，并在医院内出血。4例患者因上消化道出血入院，1例因腹腔内出血入院。5例患者接受了胰腺切除术（2例胰头切除，3例胰尾切除），3例接受了动脉结扎和内引流术。有1例死亡（死亡率为12.5%）。该系列中的前4例患者因认为需要进一步检查或无法准确诊断出血部位而推迟了手术。所有患者均再次出血，因此需要进行急诊手术。后4例患者接受了快速检查和手术。成功治疗出血性胰腺假性囊肿需要良好的手术判断力，尤其是在非手术方法失败或不适用时。复发性出血的风险很高，这表明一旦确诊就需要立即进行干预。切除可提供确定性的控制，尽管对于血管易于接近的特定患者，可通过结扎和引流进行更保守的处理。
