急性坏死性胰腺炎合并大出血的单中心回顾性研究  

Severe hemorrhagic complications in acute necrotizing pancreatitis:a retrospective single-center study

作　　者：黄东亚 李强[1] 蒋奎荣 吴峻立 高文涛 肖斌 苗毅 Huang Dongya;Li Qiang;Jiang Kuirong;Wu Junli;Gao Wentao;Xiao Bin;Miao Yi(Department of Pancreas Center,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院胰腺中心,南京210029

出　　处：《中华肝胆外科杂志》2023年第4期246-251,共6页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金(82173206)。

摘　　要：目的探讨急性坏死性胰腺炎(ANP)合并大出血的临床特征,并分析其诊疗方法及效果。方法回顾性分析2015年9月至2020年12月南京医科大学第一附属医院胰腺中心收治的44例ANP合并大出血患者的临床资料,其中男性34例,女性10例,年龄(48.9±12.2)岁。收集患者的出血部位、出血干预措施以及治疗结果等临床资料。采用电话或门诊复诊的方式随访。结果在44例ANP合并大出血患者中,胃肠道出血8例,腹腔内出血31例,混合型出血5例。ANP起病至发生出血的时间间隔为30.5(20.8,43.0)d。胃肠道出血和混合型出血的13例患者中:4例因上消化道溃疡在内镜下成功止血;5例数字减影血管造影(DSA)检查发现出血后,经血管内栓塞成功止血;4例通过外科手术止血成功。在31例腹腔内出血患者中:24例进行DSA检查;7例未行DSA(3例因血流动力学趋于稳定予保守治疗;2例因胰腺坏死感染手术清创后24 h内出血予立即开腹手术止血;1例因家属放弃治疗未行DSA;1例在准备DSA时死亡)。在29例进行DSA的患者中,69.0%(20/29)的患者发现了血管异常,其中脾动脉出血最为常见。44例出血患者中,29.5%(13/44)采用内镜检查,内镜下止血成功4例;65.9%(29/44)采用DSA检查,通过血管内栓塞止血成功15例;31.9%(14/44)采用开腹手术止血,止血成功11例。死亡率47.7%(21/44),其中5例死于失血性休克合并多器官功能障碍综合征(MODS),16例死于脓毒症合并MODS。腹腔内出血和混合型出血患者的死亡率55.6%(20/36)高于胃肠道出血患者的死亡率12.5%(1/8),差异具有统计学意义(P=0.048)。23例存活患者截至随访完成,均未再发腹腔内和(或)消化道出血。结论大出血通常发生在ANP后1个月左右,院内死亡率较高。DSA、内镜以及外科手术是ANP合并大出血的有效止血手段。Objective To study the clinical features in patients with acute necrotizing pancreatitis(ANP)complicated by hemorrhage,and to analyze the treatments and their outcomes.Methods The clinical data of 44 ANP patients with hemorrhage managed at the Department of Pancreas Center,the First Affiliated Hospital of Nanjing Medical University from September 2015 to December 2020 were retrospectively analyzed.There were 34 males and 10 females,aged(48.9±12.2)years old.Clinical data were collected on the bleeding sites,bleeding interventions,and treatment outcomes.Follow-up visits were made by outpatients visits or telephone.Results Of the 44 patients with bleeding,8 had gastrointestinal bleeding,31 had intra-abdominal bleeding,and the remaining 5 had mixed bleeding sites.The median interval from onset of ANP to development of hemorrhage was 30.5(20.8,40.3)d.For the 13 patients with gastrointestinal bleeding and mixed sites of bleeding:4 patients were successfully treated by endoscopically for upper gastrointestinal ulcers,5 patients were successfully treated by endovascular embolization using digital subtraction angiography(DSA)to detect the sites of bleeding,and 4 patients were successfully treated by surgery.For the 31 patients with intra-abdominal hemorrhage:24 underwent DSA.For the 7 patients who did not undergo DSA,3 who were hemodynamically stable were treated conservatively,2 underwent immediate open surgery to stop bleeding within 24 h after surgical debridement of infected pancreatic necrosis,1 did not undergo DSA because the family members decided to abandon further treatment,and 1 died while preparing for DSA.For the 29 patients who underwent DSA,vascular abnormalities were found in 69.0%(20/29),with splenic artery hemorrhage being the most common.In the 44 patients with bleeding:29.5%(13/44)were examined by endoscopy,and 4 were successfully stopped by endoscopic treatment;65.9%(29/44)patients were examined by DSA,and 15 patients were successfully treated by intravascular embolization;14 patients(31.9%)were treat

关 键 词：胰腺炎 血管造影术 数字减影 出血 治疗 

分 类 号：R576[医药卫生—消化系统]