外科理论与实践2025，Vol.30Issue(2)：125-131,7.DOI:10.16139/j.1007-9610.2025.02.06
DSA在胰十二指肠切除术后迟发性出血诊断和治疗中的临床价值
Clinical value of DSA in diagnosis and treatment of delayed pancreaticoduodenectomy hemorrhage
摘要
Abstract
Objective To evaluate the clinical efficacy and application value of digital subtraction angiography(DSA)in the management of delayed pancreaticoduodenectomy(PD)hemorrhage(PPH).Methods A retrospective analysis was conducted on the clinical data of 38 patients who underwent DSA for delayed PPH at Zhongshan Hospital,Fudan University,between January 2019 and December 2024.The technical success rate and clinical outcomes of interventional treatment were the primary focus of the evaluation.Results Among 726 patients who underwent PD,38(5.2%)experienced delayed bleeding.Of these,30(78.9%)showed positive findings on DSA.The distribution of bleeding sites was as follows:gastroduodenal artery(18 cases),common hepatic artery(1 case),the first branch of the jejunal artery(2 cases),proper hepatic artery(2 cases),right hepatic artery(1 case),middle hepatic artery(1 case),left hepatic artery(3 cases),origin of the splenic artery(1 case),and right gastroepiploic artery(1 case).Interventional treatments included microcoil embolization(17 cases),microcoil combined with gelatin sponge embolization(4 cases),covered stent implantation(7 cases),and gelatin sponge embolization alone and microspheres embolization(1 case each).Successful hemostasis was achieved in 28(93.3%)patients through DSA-guided interventional treatment,while 2 patients required surgical hemostasis due to recurrent bleeding.Conclusions DSA-guided interventional embolization offers advantages such as minimal invasiveness,precise localization,and effective hemostasis,making it the preferred treatment strategy for delayed PPH.关键词
胰十二指肠切除术/胰十二指肠切除术后出血/数字减影血管造影Key words
Pancreaticoduodenectomy(PD)/Pancreaticoduodenectomy hemorrhage(PPH)/Digital subtraction angiography(DSA)分类
医药卫生引用本文复制引用
王吉文,王春艳,沈盛,刘寒,张巍,刘厚宝..DSA在胰十二指肠切除术后迟发性出血诊断和治疗中的临床价值[J].外科理论与实践,2025,30(2):125-131,7.基金项目
上海自然科学基金(23ZR1459100,22ZR1457900,22ZR1457800) （23ZR1459100,22ZR1457900,22ZR1457800）
上海市科学技术委员会重点项目(21JC1401202) （21JC1401202）
国家自然科学基金(82372832) （82372832）
