胰十二指肠切除术, 迟发型出血, 数字减影血管造影, 栓塞治疗

Objective To investigate the clinical significance and effectiveness of digital subtraction angiography (DSA) and embolization treatment in patients with delayed hemorrhage after pancreaticoduodenectomy (PD). Methods A retrospective analysis was conducted on the clinical data of 31 patients, who received DSA interventional embolization treatment for delayed hemorrhage after PD, in Hubei Provincial Hospital of Integrated Chinese and Western Medicine from Jan. 2016 to Jan. 2023, to assess the clinical effect of interventional treatment. Results The incidence rate of delayed hemorrhage after PD was 6.37% (31/487) in this study. Among the 31 patients, 22 had a positive DSA at the first time and 14 had pseudoaneurysm formation. The sites of hemorrhage included 9 cases of gastroduodenal artery, 7 cases of hepatic artery, 6 cases of superior mesenteric artery branch, 5 cases of proper hepatic artery, 3 cases of splenic artery origin, and 1 case of left gastric artery. Twelve patients were embolized with microcoils, 8 patients were embolized with microcoils and gelfoam, 9 patients were treated with covered stent, and 2 patients were embolized with gelfoam. Twenty-nine patients achieved a complete hemostasis effect after DSA and 2 patients required surgical hemostasis for recurrent bleeding after interventional embolization. Conclusion DSA and embolization treatment have less trauma, can accurately detect the bleeding vessel after PD, and achieve a safe and effective hemostasis effect in time. Therefore, DSA and embolization treatment can be used as the preferred method in treatment of delayed hemorrhage after PD.

pancreatoduodenectomy, delayed bleeding, digital subtraction angiography, emobilization treatment