急性胰腺炎并发乳糜腹水的临床特点分析  

Clinical characteristics of acute pancreatitis complicated with chylous ascites

作　　者：张明君 蒋绚 黄勍 郭晓娟[1] 刘金哲 任渝棠 姜泊 ZHANG Mingjun;JIANG Xuan;HUANG Qing;GUO Xiaojuan;LIU Jinzhe;REN Yutang;JIANG Bo(School of Clinical Medicine,Tsinghua University,Department of Gastroenterology,Beijing Tsinghua Changgung Hospital,Beijing 102218,China)

机构地区：[1]清华大学临床医学院,清华大学附属北京清华长庚医院消化内科,北京102218

出　　处：《胃肠病学和肝病学杂志》2022年第6期609-614,共6页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的探讨急性胰腺炎(acute pancreatitis,AP)并发乳糜腹水患者的临床特点。方法纳入我院及近10年文献报道的AP合并乳糜腹水的患者。对患者的临床特点、并发症、治疗方法、治疗效果等临床资料进行整理及统计,根据是否合并门脉高压分为门脉高压组、非门脉高压组。结果纳入我院患者1例及文献报道病例19例,共20例。(1)临床特点:20例患者中男11例,女9例,年龄(60.65±12.27)岁(39~80岁)。引起乳糜腹水的多为重症急性胰腺炎(severe acute pancreatitis,SAP),AP发生至发现腹水时间为2~690 d,腹水TG水平为4.12~90 mmol/L,均高于血浆2~8倍,两组患者在病因、发现腹水距胰腺炎发生时间、腹水TG水平方面差异均无统计学意义(P>0.05)。(2)并发症:20例患者中共有9例(45.00%)合并胰腺假性囊肿,两组假性囊肿发生率差异无统计学意义(P>0.05)。门脉高压组有3例合并血栓(包括门静脉、肠系膜上静脉、肺动脉血栓),非门脉高压组无血栓形成病例,差异有统计学意义(P<0.05)。门脉高压组有3例患者行影像学检查提示门静脉/脾静脉狭窄,非门脉高压组无门脉系统狭窄病例,差异有统计学意义(P<0.05)。(3)治疗及预后:20例患者治愈时间为3 d~8个月,两组患者总治疗时间差异无统计学意义(P>0.05),两组均无死亡病例。治疗方式包括:(1)9例经全肠外营养+生长抑素/奥曲肽+腹水引流治疗,其中8例治愈,1例保守治疗效果不佳,予门脉支架解除门脉高压后恢复;有2例复发;(2)2例予无脂肠内营养配合肠外营养+生长抑素治愈;(3)5例予无脂肠内营养+腹水引流治疗,3例治愈,2例效果不佳,改为全肠外营养+生长抑素后治愈。(4)2例予脾静脉/门静脉支架置入后门脉高压解除,治愈。(5)1例在胆囊术中偶然发现,腹水量极少,未治疗3 d后自愈。(6)1例经外科胰周坏死组织清创+全肠外营养+生长抑素+腹水引流治愈。两组保守治疗治愈率分别为25.00Objective To investigate the clinical characteristics of acute pancreatitis(AP)complicated with chylous ascites.Methods Patients with AP complicated with chylous ascites in our hospital and reported the literature in the past 10 years were included.The clinical data of the patients,such as clinical characteristics,complications,treatment methods,treatment effect and so on,were sorted out and counted.According to the presence of portal hypertension,patients were divided into portal hypertension group and non-portal hypertension group.Results A total of 20 cases were included,including 1 patient from our hospital and 19 cases reported in literature.(1)Clinical characteristics:among the 20 patients,11 were males and 9 were females,with the age of(60.65±12.27)years old(39-80 years old).Chylous ascites were mostly caused by severe acute pancreatitis(SAP).The time from the occurrence of AP to the discovery of ascites was 2-690 days,and the TG level in ascites was 4.12-90 mmol/L,which was 2-8 times higher than that in plasma.There were no significant differences between the two groups in the etiology,the time from the occurrence of ascites to pancreatitis,and the TG level in ascites(P>0.05).(2)Complications:there were 9 cases(45.00%)of 20 patients with pancreatic pseudocyst,and there was no significant difference in the incidence of pseudocyst between the two groups(P>0.05).There were 3 cases of thrombosis(including portal vein,superior mesenteric vein and pulmonary artery thrombosis)in the portal hypertension group,and no thrombosis in the non-portal hypertension group,the difference was statistically significant(P<0.05).There were 3 patients in the portal hypertension group with portal/splenic vein stenosis in imaging examination,while there was no portal system stenosis in the non-portal hypertension group,and the difference was statistically significant(P<0.05).(3)Treatment and prognosis:the recovery time of 20 patients ranged from 3 days to 8 months,and there was no significant difference in the total treatment ti

关 键 词：急性胰腺炎 乳糜腹水 门脉高压 

分 类 号：R576[医药卫生—消化系统]