临床误诊误治Issue(1)：80-83,4.DOI:10.3969/j.issn.1002-3429.2015.01.029
胰十二指肠切除术后假性动脉瘤破裂出血纠误挽治
Salvage Treatment of Pseudoaneurysm Rupture Hemorrhage Patient Fllowing Pancreaticoduodenectomy
梁耀杰 1杜俊东 2焦华波 2涂玉亮 2朱自满 2吴雷超 2吕金勇 2金鑫2
作者信息
- 1. 100048 辽宁 锦州，辽宁医学院 解放军总医院第一附属医院研究生培养基地
- 2. 100048北京，解放军总医院第一附属医院肝胆胰脾外科
- 折叠
摘要
Abstract
Objective To explore new ideas for the salvage treatment of pseudoaneurysm rupture hemorrhage patient following pancreaticoduodenectomy. Methods Clinical data of 1 patient with pseudoaneurysm rupture hemorrhage patient af-ter pancreaticoduodenectomy for Vater's ampullary carcinoma was retrospectively analyzed, and relevant literature was also re-viewed. Results After pancreaticoduodenectomy (3 weeks), the patient's condition was complicated with the burst of the splenic artery pseudoaneurysm rupture, and after celiac artery spring bolt and gelatin sponge embolization surgery, postopera-tive hemorrhagic shock, acute liver and kidney dysfunction occurred, and the patient was admitted to our hospital when the circulatory function became stable. Upon admission he developed hypoalbuminemia, multiple liver abscess, abdominal abscess and empyema and after repeated abscess drainage catheter, intravenous nutritional support, broad-spectrum antibiotic therapy, the patient still had persistent fever, and the relapses made the condition worse. Total parenteral nutrition support was suspen-ded and antibiotics and many other medications, endoscopic gastric jejunostomy enteral nutrition support were given, with the secondary psychological counseling and physical exercise, and the condition gradually improved, the patient was able get out of the bed after 2 months. Sleep, diet and mental condition also returned to normal and 3 months later he was discharged. Conclusion Postoperative treatment of critically ill patients should not over-rely on antibiotics and total parenteral nutrition. Attention should be paid promptly to minimally invasive abscess drainage, and enteral nutrition and psychological counseling should be strengthened and the use of antibiotics and other drugs be limited, all of which may be helpful in the rehabilitation of critically ill patients.关键词
胰十二指肠切除术/手术后并发症/动脉瘤,假性/出血/感染/营养支持/抗菌药/误诊Key words
Pancreaticoduodenectomy/Postoperative complication/Aneurysm, false/Bleeding/Infection/Nutri-tional support/Antibacterial/Misdiagnosis分类
医药卫生引用本文复制引用
梁耀杰,杜俊东,焦华波,涂玉亮,朱自满,吴雷超,吕金勇,金鑫..胰十二指肠切除术后假性动脉瘤破裂出血纠误挽治[J].临床误诊误治,2015,(1):80-83,4.
