以大量胸腔积液为首发症状的慢性胰腺炎1例报告  

Massive pleural effusion as the first symptom in chronic pancreatitis:A case report and literature review

作　　者：朱华萍[1] 汪建新[1] 崔俊昌[1] 

机构地区：[1]解放军总医院呼吸内科,北京100853

出　　处：《军医进修学院学报》2009年第3期309-310,共2页Academic Journal of Pla Postgraduate Medical School

摘　　要：目的:探讨以大量胸腔积液为首发症状的慢性胰腺炎临床特点、诊断、鉴别诊断及治疗。方法:报道1例以大量胸腔积液为首发症状的慢性胰腺炎病例,结合文献进行回顾分析。结果:本例以右侧大量胸腔积液为首发症状伴明显胸痛、憋气等症状,实验室检查胸水淀粉酶显著升高且高于血清淀粉酶水平,腹部增强CT检查显示胰头钙化、胰管扩张等慢性胰腺炎改变。按胰腺炎内科治疗并行胸腔穿刺抽液胸水逐步吸收。结论:以大量胸腔积液为首发症状的慢性胰腺炎临床少见。血液、胸水淀粉酶测定及腹部影像学检查是诊断的主要方法,多数患者按胰腺炎内科治疗胸水可吸收,久治不愈或反复发作者可考虑手术治疗。Objective： To study the characteristics, diagnosis and differential diagnosis and treatment of chronic pancreatitis with massive pleural effusion first presented and frequently occurred but without clinical evidence of pancreatitis. Methods： A case of chronic pancreatitis with massive pleural effusion as the first clinical symptom was described. Diagnosis and differential diagnosis, laboratory test and radiographic patterns of the case were analyzed, and a literature review was performed. Results ： A patient who was a long-term habitual drinker suddenly experienced severe right back and shoulder pain, and dyspnea. X-ray showed massive pleural effusion, which is usually recurrent and typically characterized by a very high concentration of amylase. Abdominal computed tomograpily scan showed calcification in the head of pancreas, dilatation of main pancreatic ducts and atrophy of pancreatic parenchyma adjacent to the pancreatic duct. The patient was conservatively treated. In the following 20 days, the patient received anti-secretory octreotide therapy, total parenteral nutrition and repeated thoracentesis or thoracic drainage. His pleural effusion was gradually resolved. The patient was discharged on day 35 with no recurrence of pleural effusion during theone month follow-up. Conclusion： Initial symptomatic massive pleural effusion and progressive elevated amylase in chronic pancreatitis patients are very rare, but they are the important indicators for the diagnosis of progressive elevated amylase in pleural effusion and abdominal radiography. Conservative treatment is necessary for most patients, and endoscopic retrograde cholangiopancreatography（ERCP） or surgery should be performed for others when conservative treatment fails.

关 键 词：胸腔积液 淀粉酶类 胰腺炎 慢性 治疗 

分 类 号：R563.9[医药卫生—呼吸系统] R576.2[医药卫生—内科学]