中国实用外科杂志

中国实用外科杂志

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胰腺炎合并胰周假性动脉瘤10例诊治分析

周书毅，黄耿文，申鼎成   

  1. 中南大学湘雅医院胰胆外科，湖南长沙 410008
  • 出版日期:2017-07-01 发布日期:2017-06-30

  • Online:2017-07-01 Published:2017-06-30

摘要：

目的    探讨胰腺炎合并胰周假性动脉瘤的早期诊断和治疗方法。方法    回顾性分析2010年1月至2016年8月中南大学湘雅医院收治的10例急性或慢性胰腺炎合并胰周假性动脉瘤病人的临床资料，包括脾动脉及分支动脉瘤4例，胰十二指肠上动脉瘤2例，肠系膜上动脉分支动脉瘤2例，胃十二指肠动脉瘤1例，胃左动脉瘤1例。随访13.4（4～74）个月。结果    术前CT和血管造影（DSA）检查的诊断准确率分别为30.0%和100.0%。假性动脉瘤的首次治疗包括介入栓塞7例和外科手术3例，手术方式包括2例胰体尾切除术+脾动脉瘤切除术+脾切除术+结肠脾曲切除术，1例胃左动脉假性动脉瘤结扎+胰腺假性囊肿内引流术。6例住院期死亡，病死率为60.0%。死亡原因主要包括多器官功能障碍2例，再次出血2例，胰周坏死积液感染2例。结论    早期诊断是提高胰腺炎合并胰周假性动脉瘤疗效的关键，介入栓塞和外科手术仍是目前主要的治疗手段，但由于胰腺炎病人个体差异较大，故合并假性动脉瘤时的处理应个体化。

关键词: 胰腺炎, 假性动脉瘤, 血管造影, 介入栓塞

Abstract:

Peripancreatic pseudoaneurysm after pancreatitis：An analysis of diagnosis and treatment of 10 cases                           ZHOU Shu-yi，HUANG Geng-wen，SHEN Ding-cheng. Department of Biliary-Pancreatic Surgery，Xiangya Hospital，Central South University，Changsha 410008，China
Corresponding author：HUANG Geng-wen，E-mail：1466471168@qq.com
Abstract    Objective    To investigate the early diagnosis and therapeutic options of peripancreatic pseudoaneurysm after pancreatitis. Methods    The clinical data of 10 cases of peripancreatic pseudoaneurysm after acute pancreatitis or chronic pancreatitis admitted between January 2010 and August 2016 in Xiangya Hospital，Central South University were analyzed retrospectively. The 10 cases of pseudoaneurysm included 4 cases of pseudoaneurysm originated from splenic artery，2 from superior pancreatic-duodenal artery，2 from branches of superior mesenteric artery，1 from gastroduodenal artery and 1 from left gastric artery. All the cases were followed up for 13.4（4-74）months. Results    The diagnostic accuracy rate of preoperative CT scan and angiography (DSA) were 30% and 100% respectively. The initial treatments included interventional radiologic embolization (7 cases) and surgeries (including 2 cases of distal pancreatectomy，resection of the splenic artery pseudoaneurysm，splenectomy and resection of splenic flexure and 1 cases of left gastric artery ligation and internal drainage of pancreatic pseudocyst). The in-hospital fatality rate was 60%. The death causes included 2 cases of MODS，2 cases of re-bleeding and 2 cases of infected pancreatic necrosis. Conclusion    Early diagnosis is the key to improve the outcome of the pseudoaneurysm in the setting of pancreatitis. Interventional radiologic embolization and surgical operation are the main treatment methods. However，due to the individualization of the pancreatitis，the management of the pseudoaneurysm should also be individualized.

Key words: pancreatitis, pseudoaneurysm, digital subtraction angiography, interventional radiologic embolization