26例致死性急性坏死性胰腺炎的临床及病理资料分析

Undetected lethal acute necrotic pancreatitis:a retrospective analysis of 26 autopsy cases

目的：探讨致死性急性坏死性胰腺炎（ＡＮＰ）的临床特点及致死因素，以改善对此类病例的早期诊断和治疗。方法：复习和分析该院３０年２６例生前未能诊断的ＡＮＰ的临床及病理资料。结果：５０％患者为４０岁以下的男性患者，病程短骤，２２例死于起病２４小时内，其中８例为瞬间死亡。病理发现２６例均有胰腺坏死，２２例有胰腺出血；并肺充血及肺水肿者１４例；冠状动脉（冠脉）粥样斑块４例，其中１例有前壁心肌坏死破裂致心包积血，１例心肌陈旧性瘢痕，４例有心肌纤维断裂；中枢神经系统脱髓鞘病变１例；２例为胸腺淋巴体质，仅１例见胆囊结石及胆囊炎。结论：此组病例胰腺病变严重，但多数患者心脏病变并不很重甚至完全无改变，推测其猝死原因可能与胰腺急性坏死强烈刺激植物神经引起冠脉痉挛或严重心律失常有关。肺部充血及肺水肿也是造成ＡＮＰ病情急速恶化的重要因素。

Objective:In order to explore the clinical feature and the principle cause of sudden death and improve the early recognition and treatment of acute necrotic pancreatitis(ANP).Methods:The clinical and pathologic data of 26 cases with ANP confirmed by necropsy were reviewed in our hospital during recent 30 years.Results:It was showed that 22 patients died within 24 hr after onset of the disease,eight of whom died suddenly.The pathologic findings were as following:pancreatic necrosis in all 26 cases and hemorrhage in 22 cases,pulmonary congestion and edema in 14 cases, coronary atheromatous plaque in four cases,myocardial infarction and rupture of anterior heart wall with hemopericardium in one case,old scar in myocardium in one case,fragmentation of myocardium in four cases,demyelinating encephalopathy in one case,status thymicolymphaticus in two cases and cholelithiasis and cholecystitis in one case.Conclusions:It is suggested that coronary artery spasm and severe arrhythmia caused by stimulation of autonomic nervous and activation of vasomotoriar meterial could play a significant role in these patients with sudden death.Also,pulmonary congestion and edema appears to be an important factor for developing fatal acute pancreatitis.In addition,the reason of misdiagnosis at admission of these patients were summarised and the clinial situations to be highly associated with ANP were proposed.