胰十二指肠切除术后并发韦尼克脑病一例并文献分析  

Wernicke Encephalopathy after Pancreaticoduodenectomy:A Case Report and Literature Review

作　　者：董文敏 李普阳 巩子星 兴伟[1] 赵亚鹏 DONG Wenmin;LI Puyang;GONG Zixing;XING Wei;ZHAO Yapeng(Department of General Surgery,Hebei Provincial Hospital of Traditional Chinese Medicine,Shijiazhuang 050011,China;Graduate School of Hebei University of Traditional Chinese Medicine,Shijiazhuang 050011,China;Department of Neurosurgery,the Affiliated Hospital of Hebei University of Traditional Chinese Medicine,Shijiazhuang 050011,China)

机构地区：[1]河北省中医院普外科,石家庄050011 [2]河北中医药大学研究生院,石家庄050011 [3]河北中医药大学附属医院神经外科,石家庄050011

出　　处：《临床误诊误治》2025年第8期6-12,共7页Clinical Misdiagnosis & Mistherapy

基　　金：河北省中医药管理局项目(2019027)。

摘　　要：目的通过探讨胰十二指肠切除术后并发韦尼克脑病(WE)的原因,提高临床医生对WE的认识,为WE的诊断、治疗、预防及腹部手术后并发症的治疗提供参考。方法回顾分析1例胰十二指肠切除术后并发WE患者的诊治经过及预后。结果患者行胰十二指肠切除术后第3天出现谵妄、胰瘘、腹腔感染等并发症,术后2个月上消化道造影示胃排空障碍,经治疗后病情好转但仍伴有食欲下降、进食后恶心呕吐、饮食减少等症状,同时伴近期记忆力下降、眼肌麻痹。治疗过程中患者突发昏迷,查头颅磁共振检查后诊断为WE,经补充维生素B 1及对症治疗后症状好转。随访11个月患者意识清楚,记忆力正常,可正常交流,但仍卧床无法站立。结论胰十二指肠切除术后患者易出现胃肠功能障碍,影响营养物质消化吸收,有效补充维生素B 1对预防WE的发生至关重要。Objective To explore the causes of development of Wernicke's encephalopathy(WE)after pancreaticoduodenectomy,so as to improve clinicians'understanding of WE and provide reference for the diagnosis,treatment and prevention of WE and the treatment of complications after abdominal surgery.Methods The diagnosis,treatment and prognosis of a patient with WE after pancreaticoduodenectomy were retrospectively analyzed.Results Delirium,pancreatic fistula,abdominal infection and other complications occurred on the third day after pancreaticoduodenectomy.At 2 months after surgery,upper gastrointestinal radiography showed delayed gastric emptying.After treatment,the patient's condition was improved,but he still had symptoms such as loss of appetite,nausea and vomiting after food intake,diet reduction,and other symptoms,as well as short-term memory loss and ophthalmoplegia.During the treatment,the patient had a sudden coma and was diagnosed with WE after cranial magnetic resonance imaging examination.The symptoms were improved after vitamin B 1 supplementation and symptomatic treatment.At 11-month follow-up,the patient was conscious,had normal memory and could communicate normally,but was still lying in bed and unable to stand.Conclusion Patients after pancreaticoduodenectomy are prone to gastrointestinal dysfunction,which affects the digestion and absorption of nutrients.Effective supplementation of vitamin B 1 is very important to prevent the occurrence of WE.

关 键 词：韦尼克脑病 维生素B 1 胰十二指肠切除术 胃排空障碍 误诊 手术后并发症 鉴别诊断 

分 类 号：R747.9[医药卫生—神经病学与精神病学]