Endovascular intervention for late postpancreaticoduodenectomy hemorrhage / 中华普通外科杂志
Chinese Journal of General Surgery
; (12): 208-212, 2019.
Article
在 Zh
| WPRIM
| ID: wpr-745821
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WPRO
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.