急性胰腺炎合并区域性门静脉高压症诊治分析  

Diagnosis and treatment of acute pancreatitis complicated with regional portal hypertension

作　　者：张春[1] 林婷[1] 张靖垚 刘司南 苗润晨 王铮[1,2] 刘昌[1,2] Zhang Chun;Lin Ting;Zhang Jingyao;Liu Sinan;Miao Runchen;Wang Zheng;Liu Chang(Surgical ICU,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院外科ICU,710061 [2]西安交通大学第一附属医院肝胆外科,710061

出　　处：《中华肝脏外科手术学电子杂志》2022年第1期48-53,共6页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家自然科学基金面上项目(81773128,81972236)。

摘　　要：目的探讨急性胰腺炎合并区域性门静脉高压症(RPH)的临床表现及诊治。方法回顾性分析2016年1月至2021年1月在西安交通大学第一附属医院诊治的9例急性胰腺炎合并RPH患者临床资料。其中男8例,女1例;平均年龄(42±16)岁。患者均签署知情同意书,符合医学伦理学规定。分析患者临床表现、实验室检查、影像学检查、诊断治疗及随访情况。结果急性胰腺炎合并RPH发生率为3.8%(9/236)。既往胰腺炎发作次数(2.7±1.1)次,距离首次胰腺炎发病时间67(21~365)d。病因包括胆源性2例,高甘油三脂血症性6例,酒精性1例。中度重症急性胰腺炎7例,重症急性胰腺炎2例。临床表现为脾大9例,贫血6例,腹痛4例,上消化道出血2例。腹部增强CT表现为脾大9例,脾门静脉曲张6例,胃底-体静脉曲张6例,孤立性胃底静脉曲张2例,腹腔积液1例;合并胰腺假性囊肿6例,其中3例合并胰腺包裹性坏死,3例感染性胰腺坏死,1例脾静脉血栓。5例行开腹胰体尾切除术+脾切除术,其中1例同时行胰腺坏死组织清除术;1例行腹腔镜胰体尾切除术+脾切除术;1例多次行微创腹膜后坏死组织清除引流术;1例因脾动脉假性动脉瘤破裂腹腔出血急诊行腹腔动脉造影栓塞术,随后行开腹胰体尾切除术+脾切除术;1例行开腹胰腺包裹性坏死引流+脾切除术。术后发生A级胰瘘2例,胃肠道功能障碍1例,均经对症支持治疗后治愈。随访期间患者均未发生消化道出血,1例发生2型糖尿病,1例消化功能不良。结论RPH是急性胰腺炎少见且严重的并发症,贫血及消化道出血是主要的临床表现,胃镜和增强CT是明确诊断的重要方式,治疗的核心是胰腺局部并发症的处理,脾切除术安全有效。Objective To investigate the clinical manifestations,diagnosis and treatment of acute pancreatitis complicated with regional portal hypertension (RPH).Methods Clinical data of 9 patients with acute pancreatitis complicated with RPH admitted to the First Affiliated Hospital of Xi’an Jiaotong University from January 2016 to January 2021 were retrospectively analyzed.Among them,8 patients were male and 1 female,aged (42±16) years on average.The informed consents of all patients were obtained and the local ethical committee approval was received.Clinical manifestation,laboratory examination,imaging examination,diagnosis,treatment and follow-up were analyzed.Results The incidence of acute pancreatitis complicated with RPH was 3.8%(9/236).The number of previous occurrence of pancreatitis was 2.7±1.1.The time interval from the initial onset of pancreatitis was 67(21-365) d.2 cases were diagnosed with biliary origin of pancreatitis,6 cases with hypertriglyceridemia-induced pancreatitis and 1 case with alcohol-induced pancreatitis.7 patients were diagnosed with moderately severe acute pancreatitis and 2 cases with severe acute pancreatitis.Clinical manifestations consisted of splenomegaly in 9 cases,anemia in 6,abdominal pain in 4 and upper gastrointestinal bleeding in 2.Abdominal contrast-enhanced CT scan showed splenomegaly in 9 cases,splenic hilar varices in 6,gastric fundus-gastric varices in 6,isolated gastric fundus varices in 2 and ascites in 1.6 patients were complicated with pancreatic pseudocysts,including 3 cases of encapsulated pancreatic necrosis,3 cases of infectious pancreatic necrosis and 1 case of splenic vein thrombosis.5 cases underwent open distal pancreatectomy + splenectomy,and 1 of them received resection of pancreatic necrotic tissues.1 case underwent laparoscopic distal pancreatectomy + splenectomy.1 case repeatedly underwent minimally invasive removal of retroperitoneal necrotic tissues and drainage.Due to abdominal hemorrhage induced by rupture of splenic artery pseudoaneurysm,1 case underwe

关 键 词：胰腺炎 高血压 门静脉 脾切除术 

分 类 号：R657.51[医药卫生—外科学]