重症急性胰腺炎伴严重腹腔感染、胆道狭窄多学科诊治1例报告
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哈尔滨医科大学附属第一医院 胰胆外科,黑龙江 哈尔滨150001

作者简介:

吴嘉文,哈尔滨医科大学附属第一医院住院医师,主要从事胰腺疾病方面的研究。

基金项目:

国家自然科学基金资助项目(82270665,82070658,82470672)。


A case report of multidisciplinary diagnosis and treatment of severe acute pancreatitis with severe abdominal infection and biliary stricture
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Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China

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    摘要:

    重症急性胰腺炎(SAP)是普通外科急危重症,病死率高,预后不佳。哈尔滨医科大学附属第一医院胰胆外科于2024年2月28日收治1例36岁男性患者,患者因“上腹痛伴发热3个月,皮肤巩膜黄染1周”入院,体查:患者共携带11枚穿刺管路,上腹部可触及3 cm×5 cm大小肿块。增强CT及磁共振胆胰管成像示急性胰腺炎。患者入院诊断为“SAP,感染性胰腺坏死,胆道狭窄”,其腹腔感染严重,术后并发症复杂,救治过程艰难。遂启动多学科协作团队(MDT)诊疗会诊程序,经3次MDT诊疗处理后,患者最终顺利康复出院。本文通过回顾该患者MDT诊治经过,并结合相关文献报道,对本病特点进行总结,以期对临床工作提供经验和借鉴。

    Abstract:

    Severe acute pancreatitis (SAP) is a critical condition in general surgery settings, characterized by high mortality and poor prognosis. On February 28, 2024, the Department of Hepatobiliary Surgery at the First Affiliated Hospital of Harbin Medical University admitted a 36-year-old male patient. The patient presented with “upper abdominal pain accompanied by fever for three months and jaundice of the skin and sclera for one week.” Physical examination revealed 11 puncture tubes, and a palpable mass measuring 3 cm × 5 cm in the upper abdomen. Enhanced CT and magnetic resonance cholangiopancreatography indicated acute pancreatitis. The patient was diagnosed with “SAP, infectious pancreatic necrosis, and biliary stenosis.” He had severe abdominal infection and complex postoperative complications, making treatment challenging. Consequently, a multidisciplinary team (MDT) consultation was initiated. After three rounds of MDT consulfation and freating, the patient ultimately recovered successfully and was discharged. This article reviews the MDT treatment process for this patient and summarizes the characteristics of this condition based on relevant literature to provide insights and experience for clinical practice.

    图1 患者双侧引流管 A:左侧7枚(网膜囊内3枚,胰腺周围1枚,左侧腹膜后2枚,左侧胸腔1枚);B:右侧4枚(胰周1枚,右侧腹膜后2枚,右侧胸腔1枚)Fig.1 Bilateral drainage tubes in the patient A: Left side with 7 tubes (3 in the omental sac, 1 around the pancreas, 2 in the left retroperitoneum, and 1 in the left thoracic cavity); B: Right side with 4 tubes (1 around the pancreas, 2 in the right retroperitoneum, and 1 in the right thoracic cavity)
    图2 患者术前胰腺增强CT A:动脉期网膜囊内坏死组织;B:动脉期胰周坏死组织;C:动脉期腹膜后及肾前坏死组织;D:静脉期网膜囊内坏死组织;E:静脉期胰周坏死组织Fig.2 Preoperative enhanced CT of the pancreas in the patient A: Necrotic tissue in the omental sac during the arterial phase; B: Peripancreatic necrotic tissue during the arterial phase; C: Retroperitoneal and perirenal necrotic tissue during the arterial phase; D: Necrotic tissue in the omental sac during the venous phase; E: Peripancreatic necrotic tissue during the venous phase
    图3 患者MRCP提示可疑肝总管与胆总管交界处狭窄Fig.3 MRCP of the patient indicates suspected stricture at the junction of the common hepatic duct and the common bile duct
    图4 经PTCD造影后提示肝总管与胆总管交界处胆管狭窄Fig.4 PTCD imaging reveals biliary stricture at the junction of the common hepatic duct and the common bile duct
    图5 患者术后胰腺CT A:胰腺周围共4枚28 F双腔引流管(箭头所示);B:右侧肾前2枚28 F双腔引流管(箭头所示)Fig.5 Postoperative CT of the pancreas in the patient A: A total of Four 28 F dual-lumen drainage tubes around the pancreas (indicated by arrows); B: Two 28 F dual-lumen drainage tubes in front of the right kidney (indicated by arrows)
    图6 上消化道造影提示DFFig.6 Upper gastrointestinal imaging indicates DF
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吴嘉文,孔瑞,胡继盛,罗岩,时嘉晨,韩云程,孙备.重症急性胰腺炎伴严重腹腔感染、胆道狭窄多学科诊治1例报告[J].中国普通外科杂志,2024,33(9):1529-1535.
DOI:10.7659/j. issn.1005-6947.2024.09.020

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  • 收稿日期:2024-07-15
  • 最后修改日期:2024-09-19
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  • 在线发布日期: 2024-10-12