노영남

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두심 마
5 years ago
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1 Purpose: Delayed massive hemorrhages from pseudoaneurysm rupture of the peripancreatic large arteries, after pancreaticoduodenectomy, are fatal. We reviewed the clinical course and outcome of bleeding pseudoaneurysms after pancreaticoduodenectomy. Method: The medical records of 905 consecutive patients who underwent pancreaticoduodenectomies between October 1994 and February 2007 were reviewed retrospectively. In 27 cases with hemorrhagic complications, pseudoaneurysms were diagnosed as the main cause of bleeding. The clinical characteristics, course, management, and outcomes were reviewed. Result: In 27 cases (3.0%) of the 905, the bleeding pseudoaneurysms were diagnosed by angiography, during surgery or clinically. In 11 cases, the hemorrhage was from the pseudoaneurysm on the ligated gastroduodenal artery-stump, in five it was from the right hepatic artery, in four from the proper hepatic artery or common hepatic artery, and two from the right gastric artery. Twelve cases had pancreatic leakage. Sentinel bleedings were observed in 21 cases, there were 11 cases of bleeding from the surgical drains, eight cases from the GI tract, and in two cases from both. In 23 cases, arterial embolization was attempted and 18 cases were successful. Four cases had secondary pseudoaneurysmal bleeding. After embolization at the common or proper hepatic artery, six cases had liver abscess or infarction and there was one case of hepatic failure. Conclusion: Delayed massive hemorrhage after pancreaticoduodenectomy should be ruled out to determine whether it is associated with an arterial pseudoaneurysm rupture. Transcatheter arterial embolization is an effective modality for control of the bleeding from an arterial pseudoaneurysm.

8 Hemorrhage after duodenopancreatectomy: impact of neoadjuvant radiochemotherapy and experience with sentinel bleeding. World J Surg 2005;29: Nonsurgical management of ruptured pseudoaneurysm in patients with hepatobiliary pancreatic diseases. Am J Gastroenterol 2001;96: Management of postoperative hemorrhage after pancreatoduodenectomy. Hepatogastroenterology 2003;50: Hemorrhage after pancreaticoduodenectomy: when is surgery still indicated Am J Surg 2007;194:3-9. Management of bleeding and leakage after pancreatic surgery. Best Pract Res Clin Gastroenterol 2004;18: Risk factors for the pancreatic leakage after pancreaticoduodenectomy Korean J HBP Surg 2005;9: Haemorrhage following pancreaticoduodenectomy: risk factors and the importance of sentinel bleed. Dig Surg 2006;23: Hemorrhage after pancreatoduodenectomy. Ann Surg 1998;227: Delayed hemorrhage after pancreaticoduodenectomy. J Am Coll Surg 2004;199: Delayed massive haemorrhage after pancreatic and biliary surgery. Br J Surg 1995;82: Visceral artery pseudoaneurysms following pancreatoduodenectomy. Arch Surg 2002;137: Coil embolization of bleeding visceral pseudoaneurysms following pancreatectomy: the importance of early angiography. Arch Surg 1998;133: Haemorrhage in pancreatic disease. Br J Surg 1989;76: Delayed massive hemorrhage after pancreatic and biliary surgery: embolization or surgery Ann Surg 2005;241:85-91.

황지웅

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