临床研究(Clinical Research)

腹部手术后腹腔干分支假性动脉瘤消化道瘘的临床分析:附5 例分析

Published at: 2015年第24卷第6期

方顺勇 1 , 蔡丽生 1 , 林小雷 1 , 洪建明 1
1 福建医科大学附属漳州市医院 普外二科,福建 漳州 363000
通讯作者 丽生 蔡 Email: cailisheng@medmail.com.cn
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2015.06.014
基金:

摘要

目的:总结分析腹部手术后腹腔干分支假性动脉瘤消化道瘘导致的迟发性消化道大出血的诊断和治疗。方法:回顾性分析自2013 年1 月—2014 年9 月腹部肿瘤术后上消化道大出血经造影证实腹腔干分支假性动脉瘤消化道瘘的5 例患者的临床资料。结果:5 例患者消化道出血时间平均为术后53.6 d;假性动脉瘤位于脾动脉2 例,位于肝总动脉2 例,位于左肝动脉1 例;造影后行栓塞治疗4 例,行覆膜支架置入1 例。无术后严重并发症及围手术死亡病例。随访时间6~16 个月,无再次假性动脉瘤破裂出血,肝总动脉覆膜支架置入患者于8 个月猝死,原因未明。结论:腹腔干分支假性动脉瘤消化道瘘是腹部手术后罕见而又致命的并发症,应提高该病的认识,其诊断及治疗首选动脉造影及血管腔内治疗,避免医源性损伤可能是减少该病发生的关键。


Clinical analysis of fistula between pseudoaneurysm of celiac trunk branches and digestive tract after abdominal surgery: a report of 5 cases

Abstract

Objective: To present and analyze the diagnosis and treatment of the delayed massive gastrointestinal hemorrhage caused by fistula formation between pseudoaneurysm of the celiac trunk branches and digestive tract following abdominal surgery. Methods: The clinical data of 5 patients from January 2013 to September 2014 who developed massive gastrointestinal hemorrhage after abdominal tumor surgery and were identified as fistula formation between pseudoaneurysm of the branches and digestive tract by angiography were analyzed. Results: Of the 5 patients, the average time to postoperative gastrointeatinal hemorrhage was 53.6 d; the pseudoaneurysm was located in the splenic artery in 2 cases, in the common hepatic artery in 2 cases and in the left hepatic artery in one case; 4 cases underwent embolization therapy after angiography, and one case underwent covered stent implantation. No severe postoperative complications or perioperative death occurred. Postoperative follow-up was conducted for 6 to 16 months, during which time, no rupture and hemorrhage of the pseudoaneurysm occurred, but there was sudden death of unknown cause in one case who had undergone common hepatic artery covered stent implantation. Conclusion: The fistula between pseudoaneurysm of celiac axis branches and digestive tract is a rare but fatal complication after abdominal surgery and its awareness should be enhanced. Angiography and endovascular repair are preferred for its diagnosis and treatment, and avoidance of iatrogenic injury may be critical for reducing the incidence of this condition.


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引用

引用本文: 顺勇 方, 丽生 蔡, 小雷 林, 建明 洪. 腹部手术后腹腔干分支假性动脉瘤消化道瘘的临床分析:附5 例分析[J]. 中国普通外科杂志, 2015, 24(6): 838-842.
Cite this article as: FANG Shunyong, CAI Lisheng, LIN Xiaolei, HONG Jianming . Clinical analysis of fistula between pseudoaneurysm of celiac trunk branches and digestive tract after abdominal surgery: a report of 5 cases[J]. Chin J Gen Surg, 2015, 24(6): 838-842.