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Imaging Diagnosis and Transcatheter Arterial Embolization for Massive Hemorrhage Due to Pseudoaneurysms Complicating Pancreatitis
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摘要:
目的 探讨胰腺炎并发假性动脉瘤大出血的影像诊断方法, 评价经导管动脉栓塞治疗的安全性与有效性。 方法 回顾性分析6例胰腺炎并发假性动脉瘤破裂大出血患者的临床表现、影像诊断、经动脉栓塞治疗情况、并发症和临床疗效。 结果 6例假性动脉瘤中3例位于脾动脉, 另3例分别位于胃十二指肠动脉、胃网膜右动脉和胰十二指肠下动脉。增强CT发现4例, 全部通过数字减影血管造影(digital subtraction angiography, DSA)明确诊断并采取经导管动脉栓塞治疗, 技术成功率和临床成功率达100%, 无严重并发症发生。 结论 增强CT和DSA是胰腺炎并发假性动脉瘤的主要诊断手段, 经导管动脉栓塞安全有效, 应作为首选治疗。 Abstract:Objective To discuss the imaging diagnosis of massive hemorrhage due to pseudoaneurysms complicating pancreatitis and evaluate the safety and effectiveness of transcatheter arterial embolization (TAE) in treating this disease. Methods For 6 patients with massive hemorrhage due to pseudoaneurysms complicating pancreatitis, the clinical manifestations, imaging findings, TAE procedures, complications, and follow-up were retrospectively analyzed. Results The locations of these 6 pseudoaneurysms included splenic artery (n=3), gastroduodenal artery (n=1), right gastroepiploic artery (n=1), and inferior pancreatioduodenal artery (n=1). Four pseudoaneurysms were detected by contrast-enhanced computed tomography (CT) and all were showed in digital subtraction angiography (DSA). TAE was performed as the first-choice management and the hemorrhage was controlled in all cases. Both the technical and clinical success rates reached 100% and no major complications occurred. Conclusions For pseudoaneurysms complicating pancreatitis, contrast-enhanced CT and DSA are ideal imaging methods. TAE is safe and effective and should be the treatment of choice for this disease. -
Key words:
- pancreatitis /
- hemorrhage /
- pseudoaneurysm /
- transcatheter arterial embolization
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图 1 剧烈腹痛伴黑便急性胰腺炎患者的CT扫描
A. CT平扫显示胰体尾部假性囊肿, 其中见不规则高密度区, CT值平均为58.4 HU, 为新鲜血肿; B.CT增强扫描显示脾动脉假性动脉瘤, 位于胰腺假性囊肿内
图 2 反复呕血黑便慢性胰腺炎急性发作患者的CT扫描
A.增强CT显示胰头区肿大伴少量渗出, 其中可见圆形高密度影, 怀疑为假性动脉瘤; B. CT MIP重建明确显示胃网膜右动脉假性动脉瘤(白箭头)
图 3 反复呕血慢性胰腺炎患者的DSA及增强CT扫描
A.首次DSA示阴性结果; B. DSA前1周，增强CT明确显示脾动脉假性动脉瘤; C.再次大呕血时，立即行DSA并斜位投照显示假性动脉瘤
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