Endovascular intervention for late postpancreaticoduodenectomy hemorrhage
10.3760/cma.j.issn.1007-631X.2019.03.005
- VernacularTitle:胰十二指肠切除术后迟发性出血的血管介入治疗
- Author:
Yanmiao HUO
1
;
Jiachang CHI
;
Jianyu YANG
;
Wei LIU
;
Junfeng ZHANG
;
Yongwei SUN
;
Rong HUA
Author Information
1. 上海交通大学医学院附属仁济医院胆胰外科 200127
- Keywords:
Pancreaticoduodenectomy;
Postoperative hemorrhage;
Transarterial embolization;
Covered stent
- From:
Chinese Journal of General Surgery
2019;34(3):208-212
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the safety,efficacy of interventional treatment for late postpancreaticoduodenectomy hemorrhage (LPPH).Methods From Jan 2008 to Dec 2017,678 patients underwent pancreaticoduodenectomy (PD).33 patients (4.9％) suffered from LPPH.30 of these 33 patients underwent diagnostic angiography and endovascular treatment,either transcatheter arterial embolization (TAE,n =21) or covered stent placement (CSP,n =9),and the other 3 underwent laparotomy.Results The incidence of LPPH is 4.9％ with a 12％ motality.The most common presentation is bleeding from abdominal drainage (24.2％) and melena (24.2％).The incidence of sentinel bleeding (SB) is 45.5％ and postoperative pancreatic fistula (POPF) is 69.7％.Intra-abdominal infection were identified in 24 patients (72.7％) and the most common pathogenic bacteria is pseudomonas aeruginosa (11/24,45.8％).The mean time between PD operation and LPPH was 17.4 days.In 21 patients receiving TAE,4 got liver damage and 2 with liver abscesses,1 died.The most common site of LPPH is GDA stump and re-bleeding occurred in 5 patients.9 patients by CSP got bleeding under control.In all 7 re-bleeding patients,2 were saved by CSP,1 was saved by TAE,while the other 4 died.Conclusion Early intervention plays an important role for LPPH.CSP is better than TAE.
