摘要
背景与目的:重症急性胰腺炎(SAP)患者病情危重、进展迅速,具有较多的并发症,其中,胰源性门静脉高压症(PPH)是一种局限性区域性的门静脉高压症。部分患者PPH代偿较好,无明显的临床症状,仅在检查时发现存在脾大等情况,只需内科保守治疗并定期随访即可;对于出现PPH相关症状的患者,目前推荐行脾脏切除术。然而SAP合并PPH的患者,其全身一般情况较差,炎性水肿和腹腔感染较重,行脾脏切除术有加重感染和出血的风险,针对该类患者的治疗方法,目前国内外缺少一定的推荐及共识。因此,本研究主要探讨部分脾动脉栓塞术(PSE)治疗有症状的SAP合并PPH患者的临床效果以及处理的指征、时机和流程方法。方法:回顾性总结2014年1月—2021年12月南京大学医学院附属金陵医院重症医学科收治的15例SAP合并PPH患者的临床资料,分析患者采用PSE治疗PPH的临床诊疗经过及预后,观察患者PPH临床症状缓解情况、实验室血常规检验结果、影像学检查结果、术后并发症情况、是否有PPH症状再发。术后3 d与1、3、6个月进行影像学评估,术前及术后1年进行SF-36生活质量量表评分。结果:15例患者入院后均给予常规补液、抗感染、肠内营养等治疗。患者行PSE至AP发病时间相差较大,中位时间为487 d。PPH相关的临床症状指:脾功能亢进、胃底静脉曲张破裂出血。15例患者中,5例仅有脾功能亢进,8例仅有胃底静脉曲张破裂出血,2例合并存在以上两种症状。患者脾脏栓塞面积的中位数为60%。7例患者存在脾功能亢进,术后外周血细胞均有不同程度的恢复,随访6个月时,患者血细胞计数基本恢复正常。8例反复出现上消化道出血的患者,术后呕血、黑便症状、胃底静脉曲张明显缓解。2例患者并发脾脓肿,予以抗生素治疗并行经皮脾脓肿穿刺置管引流术后,治疗后好转拔管出院。随访1年时间,15例患者均�
Background and Aims:Patients with severe acute pancreatitis(SAP)have a critical and rapidly progressing condition with many complications.Among them,pancreatic portal hypertension(PPH)is a localized and regional portal hypertension.Some patients with PPH are well compensated and have no obvious clinical symptoms,and only spleen enlargement is found during examination,for whom only conservative internal medicine treatment and regular follow-up are needed.For patients with PPHrelated symptoms,splenectomy is currently recommended.However,SAP patients combined with PPH generally have a poor overall condition,with greater inflammatory edema and abdominal infection,splenectomy may increase the risk of infection and bleeding.There is currently a lack of recommendations and consensus on treatment methods for such patients both domestically and abroad.Therefore,this study was performed mainly to investigate the clinical efficacy of partial splenic artery embolization(PSE)in the treatment of symptomatic SAP patients with concomitant PPH,as well as the indications,timing,and procedural methods for treatment.Methods:The clinical data of 15 patients with SAP and concomitant PPH admitted to the Center for Severe Pancreatitis of Jinling Hospital Affiliated with Nanjing Medical University from January 2014 to December 2021 were retrospectively summarized.The clinical diagnosis and treatment process and prognosis of the patients undergoing PSE therapy for PPH were analyzed,and the relief of PPH clinical symptoms,results of laboratory blood routine tests and imaging examinations,postoperative complications,and recurrence of PPH symptoms of the patients were observed.Imaging evaluations were performed on 3 d as well as 1,3,and 6 months after operation,and SF-36 quality of life scale scores were assessed before and 1 year after operation.Results:All 15 patients received routine treatment including fluid infusion,anti-infection therapy,and enteral nutrition after admission.The median time from AP onset to PSE surgery varied greatly a
作者
张宗文
周晶
皋林
李刚
叶博
张敬柱
柯路
童智慧
李维勤
ZHANG Zongwen;ZHOU Jing;GAO Lin;LI Gang;YE Bo;ZHANG Jingzhu;KE Lu;TONG Zhihui;LI Weiqin(Department of Critical Care Medicine,Jinling Hospital,Medical School of Nanjing University,Nanjing 210002,China;Department of Critical Care Medicine,Jinling Hospital,Nanjing Medical University,Nanjing 210002,China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2023年第3期408-415,共8页
China Journal of General Surgery
基金
国家自然科学基金资助项目(81900592)。
关键词
胰腺炎
急性坏死性
高血压
门静脉
部分脾动脉栓塞术
Pancreatitis,Acute Necrotizing
Hypertension,Portal
Partial Splenic ArteryEmbolization
