Interventional treatment for delayed postoperative hemorrhage after gastric and pancreatic-biliary surgery

doi:10.3877/cma.j.issn.2095-5782.2024.01.007

Abstract

Abstract:

Objective

To evaluate the clinical efficacy and safety of interventional treatment for delayed hemorrhage after gastric and pancreatic-biliary surgery.

Methods

The clinical data of 24 patients with delayed hemorrhage after gastric and pancreatic-biliary surgery treated by the authors' hospital from January 2016 to June 2021 were retrospectively analyzed. The primary endpoints were the technical success and the clinical efficacy rate, and the secondary endpoints were interventional treatment-related complications.

Results

The responsible arteries were identified by angiography in all cases, and the diagnostic positive rate was 100%. Embolization failed in two cases which underwent the second surgery, and the overall technical success rate was 91.7%.15 cases were cured and discharged after treatment. The second interventional treatment was performed in 4 cases with recurrent bleeding, and 3 patients died during hospitalization. The overall clinical efficacy rate was 62.5%. The interventional treatment-related complications included liver ischemia in 5 cases, liver infarction in 2 cases and spleen infarction in 2 cases. The overall complication rate was 37.5%. The cases were divided into the extrahepatic hepatic artery group (n = 11) and the other artery group (n = 13) according to different responsible arteries. There was no significant difference in the technical success rate and the clinical efficacy rate between the two groups (P > 0.05), but the difference of the interventional treatment-related complication rate between the two groups was significant (P = 0.033).

Conclusion

Interventional treatment could be the first choice for delayed hemorrhage after gastric and pancreatic-biliary surgery due to its high diagnostic positive rate, definite therapeutic effect and rare serious complications.

Key words: Delayed hemorrhage, Interventional treatment, Gastric and pancreatic-biliary surgery

Tao Chen, Hongjian Shi, Liang Zhou, Zhen Gan. Interventional treatment for delayed postoperative hemorrhage after gastric and pancreatic-biliary surgery[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2024, 12(01): 39-44.

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Figures/Tables 6

References 19

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项目	总体(24例)	肝外肝动脉组(11例)	其他动脉组(13例)	P值
性别[例(%)]				0.357
男性	18 (75.0)	7 (63.6)	11 (84.6)
女性	6 (25.0)	4 (36.4)	2 (15.4)
年龄(岁，±s)	63.6±13.2	64.2±13.8	63.1±13.3	0.844
原发疾病[例(%)]				0.999
胰腺癌	9 (37.5)	5 (45.5)	4 (30.8)
胃癌	5 (20.8)	2 (18.2)	3 (23.1)
胆管癌	3 (12.5)	2 (18.2)	1 (7.7)
胰腺囊腺瘤	2 (8.3)	0 (0.0)	2 (15.4)
重症胰腺炎	2 (8.3)	0 (0.0)	2 (15.4)
壶腹癌	2 (8.3)	1 (9.1)	1 (7.7)
胰腺神经源性肿瘤	1 (4.2)	1 (9.1)	0 (0.0)
术式[例(%)]				0.041
胰十二指肠切除	14 (58.3)	9 (81.8)	5 (38.5)
胃切除	5 (20.8)	2 (18.2)	3 (23.1)
重症胰腺炎清创引流	2 (8.3)	0 (0.0)	2 (15.4)
胰腺消融及胆肠吻合	2 (8.3)	0 (0.0)	2 (15.4)
胰体尾切除	1 (4.2)	0 (0.0)	1 (7.7)
临床表现[例(%)]
窦道或引流管出血	15 (62.5)	6 (54.5)	9 (69.2)	0.999
血便	5 (20.8)	2 (18.2)	3 (23.1)
腹腔出血	3 (12.5)	2 (18.2)	1 (7.7)
窦道出血及血便	1 (4.2)	1 (9.1)	0 (0.0)
消化道瘘[例(%)]				0.240
肠瘘	4 (16.7)	2 (18.2)	2 (15.4)
胰瘘	8 (33.3)	4 (36.4)	4 (30.8)
胆瘘	2 (8.3)	2 (18.2)	0 (0.0)
没有或不确定	10 (41.7)	3 (27.3)	7 (53.8)
出血间隔时间(d，±s)	17.4±14.8	21.4±9.2	14.1±17.9	0.237
血红蛋白变化( g/L，±s)	34.8±9.7	40.2±6.3	30.2±10.0	0.009
休克指数(±s)	1.46±0.38	1.64±0.28	1.31±0.40	0.034

项目	总体(24例)	肝外肝动脉组(11例)	其他动脉组(13例)	P值
性别[例(%)]				0.357
男性	18 (75.0)	7 (63.6)	11 (84.6)
女性	6 (25.0)	4 (36.4)	2 (15.4)
年龄(岁，±s)	63.6±13.2	64.2±13.8	63.1±13.3	0.844
原发疾病[例(%)]				0.999
胰腺癌	9 (37.5)	5 (45.5)	4 (30.8)
胃癌	5 (20.8)	2 (18.2)	3 (23.1)
胆管癌	3 (12.5)	2 (18.2)	1 (7.7)
胰腺囊腺瘤	2 (8.3)	0 (0.0)	2 (15.4)
重症胰腺炎	2 (8.3)	0 (0.0)	2 (15.4)
壶腹癌	2 (8.3)	1 (9.1)	1 (7.7)
胰腺神经源性肿瘤	1 (4.2)	1 (9.1)	0 (0.0)
术式[例(%)]				0.041
胰十二指肠切除	14 (58.3)	9 (81.8)	5 (38.5)
胃切除	5 (20.8)	2 (18.2)	3 (23.1)
重症胰腺炎清创引流	2 (8.3)	0 (0.0)	2 (15.4)
胰腺消融及胆肠吻合	2 (8.3)	0 (0.0)	2 (15.4)
胰体尾切除	1 (4.2)	0 (0.0)	1 (7.7)
临床表现[例(%)]
窦道或引流管出血	15 (62.5)	6 (54.5)	9 (69.2)	0.999
血便	5 (20.8)	2 (18.2)	3 (23.1)
腹腔出血	3 (12.5)	2 (18.2)	1 (7.7)
窦道出血及血便	1 (4.2)	1 (9.1)	0 (0.0)
消化道瘘[例(%)]				0.240
肠瘘	4 (16.7)	2 (18.2)	2 (15.4)
胰瘘	8 (33.3)	4 (36.4)	4 (30.8)
胆瘘	2 (8.3)	2 (18.2)	0 (0.0)
没有或不确定	10 (41.7)	3 (27.3)	7 (53.8)
出血间隔时间(d，±s)	17.4±14.8	21.4±9.2	14.1±17.9	0.237
血红蛋白变化( g/L，±s)	34.8±9.7	40.2±6.3	30.2±10.0	0.009
休克指数(±s)	1.46±0.38	1.64±0.28	1.31±0.40	0.034

项目	总体(24例)	肝外肝动脉组(11例)	其他动脉组(13例)	P值
责任血管				<0.001
胃十二指肠动脉残端	5 (20.8)	5 (45.5)	0 (0.0)
肝总动脉	4 (16.7)	4 (36.4)	0 (0.0)
脾动脉	4 (16.7)	0 (0.0)	4 (30.8)
空肠动脉	3 (12.5)	0 (0.0)	3 (23.1)
肝固有动脉	2 (8.3)	2 (18.2)	0 (0.0)
胃十二指肠动脉	2 (8.3)	0 (0.0)	2 (15.4)
胰十二指肠动脉	2 (8.3)	0 (0.0)	2 (15.4)
胃左动脉	1 (4.2)	0 (0.0)	1 (7.7)
膈下动脉	1 (4.2)	0 (0.0)	1 (7.7)
DSA表现				0.999
血管破裂	15 (62.5)	7 (63.6)	8 (61.5)
假性动脉瘤形成	9 (37.5)	4 (36.4)	5 (38.5)
栓塞材料				0.065
微弹簧圈	12 (50.0)	7 (63.6)	5 (38.5)
医用胶	5 (20.8)	0 (0)	5(38.5)
微弹簧圈和医用胶	3 (12.5)	1 (9.1)	2 (15.4)
覆膜支架	2 (8.3)	2 (18.2)	0 (0.0)
未栓塞	2 (8.3)	1 (9.1)	1 (7.7)

项目	总体(24例)	肝外肝动脉组(11例)	其他动脉组(13例)	P值
责任血管				<0.001
胃十二指肠动脉残端	5 (20.8)	5 (45.5)	0 (0.0)
肝总动脉	4 (16.7)	4 (36.4)	0 (0.0)
脾动脉	4 (16.7)	0 (0.0)	4 (30.8)
空肠动脉	3 (12.5)	0 (0.0)	3 (23.1)
肝固有动脉	2 (8.3)	2 (18.2)	0 (0.0)
胃十二指肠动脉	2 (8.3)	0 (0.0)	2 (15.4)
胰十二指肠动脉	2 (8.3)	0 (0.0)	2 (15.4)
胃左动脉	1 (4.2)	0 (0.0)	1 (7.7)
膈下动脉	1 (4.2)	0 (0.0)	1 (7.7)
DSA表现				0.999
血管破裂	15 (62.5)	7 (63.6)	8 (61.5)
假性动脉瘤形成	9 (37.5)	4 (36.4)	5 (38.5)
栓塞材料				0.065
微弹簧圈	12 (50.0)	7 (63.6)	5 (38.5)
医用胶	5 (20.8)	0 (0)	5(38.5)
微弹簧圈和医用胶	3 (12.5)	1 (9.1)	2 (15.4)
覆膜支架	2 (8.3)	2 (18.2)	0 (0.0)
未栓塞	2 (8.3)	1 (9.1)	1 (7.7)

项目	总体(24例)	肝外肝动脉组(11例)	其他动脉组(13例)	P值
结局				0.835
治愈	15 (62.5)	7 (63.6)	8 (61.5)
复发	4 (16.7)	1 (9.1)	3 (23.1)
二次手术	2 (8.3)	1 (9.1)	1 (7.7)
死亡	3 (12.5)	2 (18.2)	1 (7.7)
诊断阳性率	24 (100.0)	11 (100.0)	13 (100.0)	0.999
技术成功率	22 (91.7)	10 (90.9)	12 (92.3)	0.999
临床有效率	15 (62.5)	7 (63.6)	8 (61.5)	0.999
并发症	9 (37.5)	7 (63.6)	2 (15.4)	0.033
肝脏缺血	5 (20.8)	5 (45.5)	0 (0.0)
肝脏梗塞	2 (8.3)	2 (18.2)	0 (0.0)
脾脏梗塞	2 (8.3)	0 (0.0)	2 (15.4)
并发症CIRSE分级
一级或二级	7 (29.2)	5 (45.5)	2 (15.4)
三级及以上	2 (8.3)	2 (18.2)	0 (0.0)

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