胰腺炎合并胰周假性动脉瘤10例诊治分析

发布时间：2018-11-06 11:35

【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。
[Abstract]:Objective to investigate the early diagnosis and treatment of pancreatitis with peripancreatic pseudoaneurysm. Methods the clinical data of 10 cases of acute or chronic pancreatitis with peripancreatic pseudoaneurysm, including 4 cases of splenic artery and branch aneurysm, were analyzed retrospectively from January 2010 to August 2016 in Xiangya Hospital of Central South University. There were 2 cases of superior pancreaticoduodenal aneurysm, 2 cases of branch aneurysm of superior mesenteric artery, 1 case of gastroduodenal aneurysm and 1 case of left gastric artery aneurysm. The follow-up was 13.4 (4 / 74) months. Results the diagnostic accuracy of preoperative CT and angiography (DSA) were 30.0% and 100.0%, respectively. The first treatment of pseudoaneurysm included interventional embolization in 7 cases and surgical treatment in 3 cases. One case of left gastric artery pseudoaneurysm ligated pancreatic pseudocyst internal drainage. 6 cases died in hospital, the mortality was 60. 0%. The main causes of death included multiple organ dysfunction in 2 cases, rebleeding in 2 cases, peripancreatic necrotic effusion infection in 2 cases. Conclusion early diagnosis is the key to improve the curative effect of pancreatitis with peripancreatic pseudoaneurysm. Interventional embolization and surgery are still the main treatment methods. Therefore, the treatment of pseudoaneurysm should be individualized.
【作者单位】：中南大学湘雅医院胰胆外科;
【基金】：中南大学湘雅医院管理研究基金(No.2016GL12)
【分类号】：R576

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