ПЕРВЫЙ ОПЫТ ИСПОЛЬЗОВАНИЯ ЭМБОЛИЗАЦИИ И СИСТЕМНОГО ВВЕДЕНИЯ ФАКТОРОВ СВЕРТЫВАНИЯ В КОМПЛЕКСНОМ ЛЕЧЕНИИ РЕЦИДИВНОГО АРРОЗИВНОГО КРОВОТЕЧЕНИЯ ПРИ ПАНКРЕОНЕКРОЗЕ
Клинический случай
Дата публикации: марта 28, 2024
Ключевые слова
кровотечение
панкреатит
эмболизация селезеночной артерии
панкреатит
эмболизация селезеночной артерии
Аннотация
Течение тяжелого острого панкреатита/панкреонекроза, осложненного кровотечением, связано с конечным неблагоприятным исходом лечения этой группы больных. Наибольшую трудность представляют собой аррозивные парапанкреатические внутрибрюшные кровотечения без четкой артериографической локализации на этапе развития гнойно-септических осложнений панкреонекроза. Они практически всегда фатальные. Цель исследования – оценить эффективность и безопасность эндоваскулярной эмболизации и введения факторов свертывания в лечении аррозивных кровотечений при остром панкреатите. Материалы и методы. В статье представлены первый клинический опыт использования эндоваскулярной тотальной эмболизации ведущего артериального сосуда (селезеночной артерии), замедляющей кровоток в поджелудочной железе, и дальнейшее системное введение факторов свертывания, которое в условиях замедленного кровотока позволяет формировать устойчивый сосудистый сгусток (устойчивый гемостаз) в условиях невозможности хирургического доступа к зоне кровотечения. Результаты. Представленная методика позволила обеспечить устойчивый гемостаз при парапанкреатическом аррозивном кровотечении. Заключение. Эмболизация крупного артериального сосуда, кровоснабжающего поджелудочную железу, в сочетании с системным использованием факторов свертывания открывает перспективы остановки практически фатального парапанкреатического внутрибрюшного кровотечения на этапе гнойно-септических осложнений панкреонекроза.Литература
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2. Ammori B.J. et al. Haemorrhagic complications of pancreatitis: presentation, diagnosis and management // Annals of the Royal College of Surgeons of England. – 1998. – V. 80. – No. 5. – P. 316.
3. Andersson E. et al. Major haemorrhagic complications of acute pancreatitis // Br. J. Surg. – 2010. –V. 97. – No. 9. – P. 1379–1384. DOI: 10.1002/bjs.7113.
4. Balachandra S. et al. Systematic appraisal of the management of the major vascular complications of pancreatitis // Am. J. Surg. – 2005. – V. 190. – P. 489–495. DOI: 10.1016/j.amjsurg.2005.03.009.
5. Balthazar E.J. Complications of acute pancreatitis: clinical and CT evaluation // Radiol. Clin. North Am. – 2002. – V. 40. – P. 1211–1227.
6. Balthazar E.J. et al. Hemorrhagic complications of pancreatitis: radiologic evaluation with emphasis on CT imaging // Pancreatology. – 2001. –V. 1. – No. 4. – P. 306–313.
7. Banks P.A. et al. Classification of acute pancreatitis – 2012: revision of the Atlanta classification and definitions by international consensus // Gut. – 2013. – V. 62. – No. 1. – P. 102–111.
8. Bergert H. et al. Management and outcome of hemorrhage due to arterial pseudoaneurysms in pancreatitis // Surgery. – 2005. – V. 137. – No. 3. – P. 323–328.
9. Evans R.P.T. et al. Pancreatitis: Preventing catastrophic haemorrhage // World Journal of Gastroenterology. – 2017. – V. 23. – No. 30. – P. 5460.
10. Flati G. et al. Potentially fatal bleeding in acute pancreatitis: pathophysiology, prevention, and treatment // Pancreas. – 2003. – V. 26. – No. 1. – P. 8–14.
11. Gupta V. et al. Treatment strategies for bleeding from gastroduodenal artery pseudoaneurysms complicating the course of chronic pancreatitis – a case series of 10 patients // Indian Journal of Gastroenterology. – 2018. – V. 37. – P. 457–463.
12. Gupta V. et al. Hemorrhage complicating the course of severe acute pancreatitis // Annals of Hepato-biliary-pancreatic Surgery. – 2020. – V. 24. – No. 3. – P. 292–300.
13. Labarca E. et al. Early predictors of abdominal hemorrhage among critically ill patients with pancreatitis: a prospective cohort study // Pancreas. – 2018. – V. 47. – No. 8. – P. 1027–1032.
14. Law N.M. et al. Emergency complications of acute and chronic pancreatitis // Gastroenterol. Clin. North Am. – 2003. – V. 32. – P. 1169–1194.
15. Mallick B. et al. Impact of timing of presentation of acute pancreatitis to a tertiary care centre on the outcome // Pancreatology. – 2019. – V. 19. – No. 1. – P. 143–148.
16. Manrai M. et al. Outcome of acute pancreatic and peripancreatic collections occurring in patients with acute pancreatitis // Annals of surgery. – 2018. – V. 267. – No. 2. – P. 357–363.
17. Mendelson R.M. et al. Vascular complications of pancreatitis // ANZ J. Surg. – 2005. – V. 75. – No. 12. – P. 1073–1079.
18. Sharma P.K. et al. Hemorrhage in acute pancreatitis: should gastrointestinal bleeding be considered an organ failure? // Pancreas. – 2008. – V. 36. – P. 141–145.
19. Shen X. et al. Risk factors and outcome for massive intra-abdominal bleeding among patients with infected necrotizing pancreatitis // Medicine (Baltimore). – 2015. – V. 94. – P. e1172.
20. Tang M.Y. et al. MR imaging of hemorrhage associated with acute pancreatitis // Pancreatology. – 2018. – V. 18 – P. 363–369.
21. Udd M. et al. Treatment of bleeding pseudoaneurysms in patients with chronic pancreatitis // World J. Surg. – 2007. – V. 31. – P. 504–510.
22. Wei A.L. et al. Early complications after interventions in patients with acute pancreatitis // World J. Gastroenterol. – 2016. – V. 22. – P. 2828–2836.
23. Yamaguchi T. et al. Acute necrotizing pancreatitis as a fatal complication following DC Bead transcatheter arterial chemoembolization for hepatocellular carcinoma: a case report and review of the literature // Molecular and Clinical Oncology. – 2018. – V. 9. – No. 4. – P. 403–407.