重症急性胰腺炎合并上消化道出血的诊治

Diagnosis and treatment of severe acute pancreatitis complicated with upper gastrointestinal hemorrhage

目的：探讨重症急性胰腺炎合并上消化道大出血的诊断和治疗。方法：回顾分析1998—05—2005—06我院收治的18例重症急性胰腺炎并发上消化道出血患者的临床资料。结果：急性胃黏膜病变出血13例，保守治疗10例，死亡4例；手术治疗3例，死亡1例。消化性溃疡手术治疗2例，死亡1例；胃镜下止血1例，止血成功。胃底静脉曲张出血2例病人经手术切除脾脏后治愈。结论：对于重症急性胰腺炎合并上消化道大出血的患者的治疗应在保守治疗的基础上积极手术治疗，但手术治疗应简单有效，对于区域性门脉高压引起的出血应选择脾切除手术。

Objective：To explore the diagnosis and treatment of severe acute pancreatitis complicated with upper gastrointestinal haemorrhage. Methods. A total of 18 cases of severe acute pancreatitis with upper gastrointestinal hemorrhage from May 1998 to Jun 2005 were enrolled and analyzed retrospectively. Results： Of all the cases, 13 cases were caused by acute gastric mucosal lesions, among them, 10 cases were treated by non -operational methods, 4 of them died, and the other 3 cases were treated by operation, 1 of them died. Three cases were caused by gastric ulcer and duodenal ulcer, 2 cases were treated by operation, 1 of them died, and the other case was treated successfully by endoscopic hemostasis. Two cases were caused by isolated gastric varices due to regional portal hypertension, and both of them were cured by splenectomy. Conclusion： Surgical operation should be taken positively during medical treatment for selective patients with severe acute pancreatitis complicated with upper gastrointestinal hemorrhage, but the surgical procedure should be simple and effective. Splenectomy may be an effective treatment option for regional portal hypertension.