重症急性胰腺炎合并消化道瘘的临床特点分析  

Clinical Characteristics of Severe Acute Pancreatitis with Digestive Fistula

作　　者：何益信 李颖霞[1] 姜利彬 温洪涛[1] HE Yixin;LI Yingxia;JIANG Libin;WEN Hongtao(Department of Gastroenterology,the First Affiliated Hospitai of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院消化内科,河南郑州450000

出　　处：《河南医学研究》2021年第24期4449-4453,共5页Henan Medical Research

摘　　要：目的探讨重症急性胰腺炎(SAP)合并消化道瘘的临床特点。方法回顾性分析郑州大学第一附属医院2018年4月至2020年10月收治的13例急性重症胰腺炎合并消化道瘘的患者的临床资料,运用统计学方法描述其一般资料、发病部位及时间、病因、临床表现、实验室检查、影像学检查、治疗及转归等临床特点。结果SAP合并消化道瘘患者病因以酒精性为主(38.46%,5/13),其次为胆源性(15.38%,2/13)和暴饮暴食(15.38%,2/13);部位以十二指肠瘘居多(53.85%,7/13),且主要位于十二指肠球降移行处,结肠瘘次之(23.08%,3/13);消化道瘘发生于SAP后2~26周,中位时间为6周;临床表现以腹痛、腹胀及发热为主,引流管可见引流出胃肠内容物,钡餐检查可见腹腔团片状对比剂和游离对比剂,内镜可直观发现瘘口的存在;12例患者主要采取内镜下钛夹夹闭修补瘘口、高位消化道瘘(胃十二指肠)通过空肠营养管越过瘘口恢复肠内营养、小肠瘘及结肠瘘的肠管临时性造瘘并择期还纳等非手术切除治疗,其中7例患者瘘口愈合,3例患者瘘口无好转,2例死亡,治愈率达58.33%;1例降结肠瘘患者行外科手术切除包含瘘管的肠段,随访过程中患者一般情况良好。结论SAP患者合并消化道瘘的病因主要为酒精性胰腺炎,部位以十二指肠瘘居多,瘘口的发生与SAP的中位间隔时间为6周。密切观察引流液性质的改变有助于早期发现消化道瘘。目前治疗以非手术切除方式为主,具体的治疗方式根据瘘口情况而定。Objective To investigate the clinical characteristics of severe acute pancreatitis(SAP)complicated with digestive tract fistula.Methods The clinical datas of 13 patients with acute severe pancreatitis and gastrointestinal fistula admitted to the First Affiliated Hospital of Zhengzhou University from April 2018 to October 2020 were retrospectively analyzed.Statistical methods were used to describe the clinical features such as general data,location and time of onset,etiology,clinical manifestations,laboratory examination,imaging examination,treatment and outcome.Results The main etiology of SAP complicated with gastrointestinal fistula was alcoholic(38.46%,5/13),followed by biliary(15.38%,2/13)and overeating(15.38%,2/13).Most of the gastrointestinal fistula was duodenal fistula(53.85%,7/13),and it was mainly located in the descending transition of duodenal bulb,followed by colonic fistula(23.08%,3/13).Gastrointestinal fistula occured at 2-26 weeks after SAP,with a median time of 6 weeks.Clinical manifestations were mainly abdominal pain,bloating,and fever.Drainage tube showed gastrointestinal contents.Barium meal examination showed the abdominal mass tablet contrast agent and free contrast agent.Endoscopy could directly find the existence of fistula.Twelve patients were mainly treated with endoscopic titanium clip to repair fistula,high gastrointestinal fistula(gastroduodenal)using jejunal nutrition tube to cross the fistula to restore enteral nutrition,small intestinal fistula and colonic fistula receiving temporary intestinal fistula and elective return,etc.Among them,7 patients with fistula healed,3 patients with fistula did not improve,2 cases died,and the cure rate was 58.33%.One patient with descending colon fistula underwent surgical resection of the intestinal segment containing the fistula.During the follow-up,the patient was generally in good condition.Conclusion The main cause of gastrointestinal fistula in patients with SAP is alcoholic pancreatitis,most of which is duodenal fistula.The median interval

关 键 词：急性重症胰腺炎 胃瘘 肠瘘 

分 类 号：R576[医药卫生—消化系统]