Diagnosis and treatment of hemobilia from ruptured false aneurysms after hepatobiliary surgery: An analysis of 14 cases
Objective To investigate the diagnosis, treatment, and prevention of hemobilia from ruptured false aneurysms after hepatobiliary surgery.Methods A retrospective analysis was performed on the clinical data of 14 patients with hemobilia from ruptured false aneurysms after hepatobiliary surgery who were admitted to Department of Hepatobiliary Surgery, Chinese PLA General Hospital from January 2002 to March 2012.These patients were divided into three groups to receive conservative treatment, exploratory laparotomy and hemostasis (done immediately after hemobilia) , or selective digital subtraction angiography (DSA) and transhepatic arterial embolization (TAE) (done immediately after hemobilia) .The key points of diagnosis and treatment and preventive measures were investigated.Results Of the 14 patients, 6 died, and 8 were cured.Conservative treatment was performed in 2 patients, but failed in both of them (100%) ;then, the 2 cases underwent DSA and received TAE, and one of them died.Five patients received exploratory laparotomy and hemostasis;2 cases (40%) were cured after confirmed diagnosis, and the other 3 cases then underwent DSA and received TAE after operation, with one dead.Three patients received selective DSA and TAE immediately after hemobilia;all the 3 cases (100%) had a confirmed diagnosis and were cured.Selective DSA was performed in 8 patients, and all (100%) of them had a confirmed diagnosis.TAE was done 9 times in 8 patients, and 8 times (89%) of TAE were effective;6 cases (75%) were cured, 1 case received TAE twice, and 2 cases died after TAE.Of all the dead cases, 4 suffered sudden death, 1 died of liver failure after 2 times TAE, and 1 died of multiple organ failure after laparotomy and TAE.Conclusion Early diagnosis and treatment are essential for hemobilia from ruptured false aneurysms after hepatobiliary surgery;selective DSA is the optimal diagnostic method, and TAE should be the first choice of treatment.The formation of false aneurysms after hepatobiliary surgery is related to surgical operation, and more attention should be directed to prevention.
Li XG, Zhang XB, Shi HF, et al.Imaging Diagnosis and transcath-eter arterial embolization for massive hemorrhage due to pseudoaneu-rysms complicating pancreatitis[J].Med J Peking Union Med Col-lege Hosp, 2010, 1 (1) :77-81. (in Chinese) 李晓光, 张晓波, 金征宇, 等.胰腺炎并发假性动脉瘤大出血的影像诊断及其经导管动脉栓塞治疗[J].协和医学杂志, 2010, 1 (1) :77-81. Kriwanek S, Gschwantler M, Beckerhinn P, et al.Complication-safter surgery for necrotising pancreatitis:risk factors and prognosis[J].Eur J Surg, 1999, 165 (7) :952-957. Beattie GC, Hardman JG, R edhead D, et al.Evidence for a cen-tralrole for selective mesenteric angiography in the management ofthe major vascular complications of pancreatitis[J].Am J Surg, 2003, 185 (19) :96. Shibata T, Sagoh T, Ametani F, et al.Transcatheter microcoil em-bolotherapy for ruptured pseudo aneurysm following pancreatic andbiliary surgery[J].Cardiovasc Intervent Radiol, 2002, 25 (21) :180. Tessier DJ, Fowl RJ, Stone WM, et al.Iatrogenic Hepatic arterypseudoaneurysms:an uncommon complication afterhepatic, biliary, andpancreatic procedures[J].Ann Vasc Surg, 2003, 17 (31) :663-669.  Huang JF.Surgery of the Liver, Biliary Tract and Pancreas[M].Beijing:People's Medical Publishing House, 2010:1050, 1065. (in Chinese) 黄洁夫.肝胆胰外科学[M].北京:人民卫生出版社, 2010:1050, 1065. Kassasseye A, Ziyani F, Roffet F.Hemohilia after laparoscopic cys-tectomy apropos of a case.Review of the literature[J].Ann Chir, 1997, 51:159. Zhang JX, Chen XR.Pseudoaneurysm of hepatic artery and cysticartery after laparoscopic cholecystectomy[J].Chin J HepatobiliarySurg, 2004, 10 (7) :498. (in Chinese) 张吉祥, 陈训如.腹腔镜胆囊切除术后肝动脉与胆囊动脉假性动脉瘤[J].中华肝胆外科杂志, 2004, 10 (7) :498. Li N, Li Y, Qin MF, et al.A case with hemobilia from rupturedfalse aneurysms following laparoscopic choledochotomy[J].Chin JDig Endosc, 2004, 21 (1) :35. (in Chinese) 李宁, 李湧, 秦明放.腹腔镜胆道探查术后假性动脉瘤并发胆道出血一例[J].中华消化内镜杂志, 2004, 21 (1) :35. Huang ZQ, Huang XQ, Song Q.Operative Surgery of the BiliaryTract[M].Beijing:People's Military Medical Publisher, 2010:55, 316. (in Chinese) 黄志强, 黄晓强, 宋青.黄志强胆道外科手术学[M].北京:人民军医出版社, 2010:55, 316. Lu JL, Li JY, Xu LY, et al.A case with hepatic artery bleeding af-ter PTCD[J].J Clin Hepatol, 2011, 27 (7) :755. (in Chinese) 路军良, 李京雨, 徐力扬, 等.经皮穿刺胆道引流术治疗肝动脉损伤大出血1例[J].临床肝胆病杂志, 2011, 27 (7) :755. Yoon YS, Kim SW, Her KH, et al.Management of postoperativehemorrhage after pancrea toduodenectomy[J].Hepatogastroenterol-ogy, 2003, 50 (54) :2208-2212. Emre F, Yekebas MD, Lars Wolfram, et al.Postpancreatotomyhemorrhage:diagnosisand treatment-an analysis in 1669 consecu-tive pancreati resections[J].Ann Surg, 2007, 246 (2) :269-280.  Dong JH.Biliary Surgery:Highlights and Blind Spots[M].Bei-jing:People's Medical Publishing House, 2010:271, 353, 430, 432. (in Chinese) 董家鸿.要点与盲点:胆道外科[M].北京:人民卫生出版社, 2010:271, 353, 430, 432. Huang H, Song GD, Zhang CJ, et al.Three cases with cystic arterypseudoaneurysm following laparoscopic cholecystectomy[J].Chin JPract Surg, 2001, 21 (10) :629. (in Chinese) 黄辉, 宋根达, 张纯俊, 等.腹腔镜胆囊切除术致胆囊假性动脉瘤3例报告[J].中华实用外科杂志, 2001, 21 (10) :629. Li SW, Liu CA, Wu CX.A case of bleeding with ruptured cysticartery pseudoaneurysm following laparoscopic cholecystectomy[J].Chin J Gen Surg, 2003, 18 (5) :30. (in Chinese) 李生伟, 刘长安, 吴传新.腹腔镜胆囊切除术后胆囊动脉假性动脉瘤自发破裂大出血一例[J].中华普通外科杂志, 2003, 18 (5) :30. Rivitz SM, Waltman AC, Kelsey PB.Embo lization of hepatic ar-tery pseudoaneurysm following laparoscopic cholecystectomy[J].Cardiovasc Intervent Radiol, 1996, 19 (4) :43. Lu JL, Li JY, Zhang Q, et al.Interventional treatment of visceral an-eurysms:an investigation of therapeutic technique[J].J Intervent Ra-diol, 2009, 18 (2) :90-92. (in Chinese) 路军良, 李金雨, 张强, 等.腹腔内脏血管动脉瘤的介入治疗方法探讨[J].介入放射学杂志, 2009, 18 (2) :90-92. You J, Mou W, Chen W, et al.Imaging diagnosis and interventionaltreatment of pseudoaneurysm[J].Acta Academiae Med Militaris Ter-tiae, 2002, 24 (6) :648-650. (in Chinese) 游箭, 牟玮, 陈伟, 等.假性动脉瘤的影像诊断及介入治疗[J].第三军医大学学报, 2002, 24 (6) :648-650. Savader SJ, Trerotola SO, Merine DS, et al.Hemobilia after percu-taneous transhepatic biliary drainage:treatment with transcatheterembolotherapy[J].J Vasc Interv Radiol, 1992, 3 (5) :345-352. Eurvilaichit C.Iatrogenic hemobilia:management with transarterial em-bolization using gelfoam particles[J].J Med Assoc Thai, 1999, 82 (2) :931-937.  Shibata T, Sagoh T, Ametani F, et al.Transcatheter microcoil em-bolotherapy for ruptured pseudoaneurysm following pancreatic andbiliary surgery[J].Cardiovasc Intervent Radiol, 2002, 25 (4) :180-185. Reber PU, Baer HU, Patel AC, et al.Superselective microcoil em-bol izalion:treatment of choice in high risk patients with extrahepat-ic pseudoaneurysms of the hepatic arteries[J].J Am Coll Surg, 1998, 186 (7) :325. Tessier DJ, Stone WM, Fowl RJ, et al.Clinical features and man-agement of splenic artery pseudoaneurysm:case series and cumula-tive review of literature[J].J Vasc Surg, 2003, 38 (11) :969. Li JP.Clinical analysis on early-stage abdominal reoperation:areport of 28 cases[J].Modern Med Health, 2005, 21 (23) :3273. (in Chinese) 李建平.腹部手术后早期再手术28例分析[J].现代医药卫生, 2005, 21 (23) :3273.  Cheng RC, Liu QY.Whether preventive drainage is needed or notafter abdominal surgery[J].Chin J Dig Surg, 2008, 7 (5) :326. (in Chinese) 程若川, 刘其雨.腹部手术后是否需要预防引流[J].中华消化外科杂志, 2008, 7 (5) :326.
- 文章访问数: 2947
- HTML全文浏览量: 7
- PDF下载量: 670
- 被引次数: 0