临床病例评析——咖啡色胸腔积液 腹部囊肿 结节红斑

Coffee colored pleural fluid-abdominal cyst--erythema nodosum

目的探讨系统性红斑狼疮（SLE）患者合并胰源性胸腔积液、胰源性脂膜炎的诊断及治疗。方法通过病史回顾、实验室特殊检查及病理检查明确诊断并分析诊疗经过。结果1例40岁女性SLE患者腹部cT显示胰腺水肿，多个胰腺假性囊肿最大230minx95mm，双侧胸腔反复出现大量包裹性积液，胸腔积液生化检查淀粉酶11327U／L，下肢皮下结节病理显示胰源性脂膜炎样改变。确诊患者为SLE合并胰腺炎、巨大胰腺假性囊肿、胰源性胸腔积液、胰源性脂膜炎。应用糖皮质激素、生长抑素、乌司他丁、鼻肠营养等保守治疗效果不佳。外科经皮穿刺引流囊肿后，患者临床症状显著改善。结论SLE患者合并胰腺假性囊肿，应警惕胰腺胸膜瘘等因素导致的胰源性胸腔积液的发生，应积极送检淀粉酶，早期囊肿引流较保守治疗更有利于控制病情。

Objective To discuss the diagnosis and treatment of systemic lupus erythematosus （SLE） patients associated with pancreatic pleural effusion and pancreatic panniculitis. Methods Retrospectively analyzed the clinical data, therapy and experiences. Results A 40-year-old female SLE patient associated with pancreatitis, huge pancreatic pseudocysts, pancreatic pleural effusion, pancreatic panniculitis. Abdominal computed tomography （CT） showed an edematous swelling of the pancreas and Several pseudocysts, the biggest one measuring 230 mm×95 mm. Markedly elevated amylase （11 327 U/L） was contained in the massive pleural effusion. Erythema nodosum tissue pathology revealed the pancreatic panniculitis. The pseudocyst did not completely resolve with high-dose steroid. Growth hormone release inhibiting hormone （GIH）, alinastatin, nasojejunal feeding, and it was later complicated by infection and rupture. After a surgical percutaneous drainage for the complicated pseudocyst, the clinical symptoms and signs were markedly improved. Conclusion This case shows the importance of performing early drainage rather than conservative treatment for pancreatic pseudocyst in patients with lupus-associated pancreatitis.