1977—2021年文献333例胰管出血病例的临床特征分析  

An analysis of the clinical characteristics of 333 cases of hemosuccus pancreaticus reported in the literature from 1977 to 2021

作　　者：王健 王成果 惠立良 段东峰 鲁建国 WANG Jian;WANG Chengguo;HUI Liliang;DUAN Dongfeng;LU Jianguo(Department of General Surgery,the Second Affiliated Hospital of Air Force Medical University,Xi'an 710038,China)

机构地区：[1]中国人民解放军空军军医大学第二附属医院普通外科,陕西西安710038

出　　处：《中国普通外科杂志》2023年第9期1370-1378,共9页China Journal of General Surgery

基　　金：国家自然科学基金青年科学基金资助项目(81001087)。

摘　　要：背景与目的:胰管出血(HP)是罕见的上消化道出血的原因,目前尚无公认的诊疗标准。本研究总结近40年来文献报道的HP患者的临床特征,以期加深对HP的认识,提高早期识别与诊断的能力,为临床规范诊疗策略方面提供一定的理论依据。方法:收集1977年1月—2021年12月公开发表关于HP的相关文献,分析HP患者的病因、临床表现、实验室检查、影像学检查、诊断治疗及预后情况。结果:纳入文献151篇,共333例患者,其中男性267例,女性66例,男女比例约为4∶1;年龄3~94岁,平均45.9岁。病因以胰腺炎(82.3%)最常见,其中慢性胰腺炎占89.1%,其次为胰周动脉瘤(6.0%)和胰腺肿瘤(5.4%)。最常见的临床表现为黑便(74.2%)和腹痛(53.8%)。影像学诊断主要依靠上消化道内镜、腹部增强CT及腹腔相关动脉造影,282例行上消化道内镜检查,共140例(49.6%)可以经内镜检查明确诊断。204例行腹部CT检查,其中假性动脉瘤120例(58.8%)、假性囊肿46例(22.5%)、胰腺肿瘤15例(7.4%)、胰周动脉瘤13例(6.4%)、胰管结石4例(2.0%)。193例患者行腹腔相关动脉造影检查,112例(58.0%)显示阳性结果。最常见出血源是脾动脉(41.2%),其次是胃十二指肠动脉(16.7%)、囊壁出血(9.9%)、胰十二指肠动脉(9.6%)。36例患者选择保守治疗。180例患者尝试了介入治疗,147例(81.7%)患者成功;140例患者接受手术治疗。9例患者选择其他治疗方式。218例患者的随访结果显示,197例(91.4%)无复发性出血,13例(6.0%)再出血,5例(2.3%)死亡。结论:HP确诊较为困难,应结合病史、临床表现综合判断,必要时进行重复的影像学检查以提高诊断率。治疗以针对病因为主导的综合治疗为主,同时根据疾病的临床进程选择恰当的治疗方式。Background and Aims:Hemosuccus pancreaticus(HP)is a rare cause of upper gastroin bleeding,and there are currently no recognized diagnostic and treatment standards.This study summarized the clinical characteristics of HP patients reported in the literature over the past four decades to enhance our understanding of HP,improve early recognition and diagnosis,and provide a theoretical basis for standardizing clinical diagnostic and treatment strategies.Methods:The relevant literature published from January 1977 to December 2021 concerning HP was collected.The etiology,clinical manifestations,laboratory tests,imaging examinations,diagnostic and treatment methods,and prognosis of HP patients were analyzed.Results:A total of 151 articles were included,comprising 333 patients,including 267 males and 66 females,with a male-to-female ratio of approximately 4∶1.The age ranged from 3 to 94 years,with an average age of 45.9 years.The most common cause was pancreatitis(82.3%),with chronic pancreatitis accounting for 89.1%,followed by peripancreatic artery aneurysm(6.0%)and pancreatic tumors(5.4%).The most common clinical manifestations were melena(74.2%)and abdominal pain(53.8%).Imaging diagnosis primarily relied on upper gastrointestinal endoscopy,contrast-enhanced abdominal CT,and celiac artery angiography.Among the 282 patients who underwent upper gastrointestinal endoscopy,140(49.6%)received a definitive diagnosis.Abdominal CT scans were performed in 204 cases,revealing pseudoaneurysms in 120 cases(58.8%),pseudocysts in 46 cases(22.5%),pancreatic tumors in 15 cases(7.4%),peripancreatic artery aneurysms in 13 cases(6.4%),and pancreatic duct stones in 4 cases(2.0%).Among the 193 patients who underwent celiac artery angiography,112(58.0%)had positive results.The most common source of bleeding was the splenic artery(41.2%),followed by the gastroduodenal artery(16.7%),bleeding from the cyst wall(9.9%),and the pancreaticoduodenal artery(9.6%).Thirty-six patients opted for conservative treatment,180 attempted interventional tre

关 键 词：出血 胰腺管 动脉瘤 假性 胰腺炎 慢性 

分 类 号：R657.5[医药卫生—外科学]