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目的探讨重症急性胰腺炎(severe acute pancreatitis,SAP)并发假性动脉瘤大出血的诊断和处理。方法回顾性分析1990年10月至2006年10月收治的12例 SAP 合并假性动脉瘤出血患者的临床资料。病因:胆源性胰腺炎6例,高脂血症3例,甲状旁腺功能亢进危象1例,原因不明2例。结果 CT 诊断假性动脉瘤出血6例(6/9),血管造影均诊断正确(12/12)。受累血管主要为胰腺周围血管。8例“一点法”(出血血管近端)栓塞后成功止血,2例“两点法”(动脉瘤出血血管的近端和远端)血管栓塞后成功止血。2例急诊手术缝扎止血。“一点法”栓塞止血患者中有4例4～7 d后再出血,2例急诊手术止血,2例改用“两点法”成功栓塞。3例死于感染和多器官功能不全综合征,总病死率为25%。结论血管造影是 SAP 并发假性动脉瘤大出血的主要诊断方法,“两点法”血管栓塞止血和急诊手术是有效的治疗手段。
Objective To investigate the diagnosis and treatment of severe acute pancreatitis (SAP) complicated with haemorrhage of pseudoaneurysm. Methods The clinical data of 12 SAP patients with pseudoaneurysm hemorrhage who were treated from October 1990 to October 2006 were analyzed retrospectively. Etiology: biliary pancreatitis in 6 cases, 3 cases of hyperlipidemia, hyperparathyroidism crisis in 1 case, 2 cases of unknown cause. Results Six cases (6/9) had CT diagnosis of pseudo aneurysm hemorrhage. Angiography was correctly diagnosed (12/12). Involved vessels mainly around the pancreas blood vessels. Eight patients had successful hemostasis after thromboembolism, and two had successful hemostasis after embolization of the “two-point method” (proximal and distal aneurysm bleeding vessels). 2 cases of emergency operation suture to stop bleeding. In the “one-point method”, 4 patients died of hemorrhage 4 to 7 days after embolization and hemostasis, while 2 patients switched to emergency using “two-point method” and successfully embolized. 3 died of infection and multiple organ dysfunction syndrome, the total case fatality rate was 25%. Conclusions Angiography is the main diagnostic method of massive hemorrhage in SAP with pseudoaneurysm. The “two-point method” of embolization and emergency surgery is an effective treatment.