高脂血症性急性胰腺炎的临床诊断与治疗（附47例报告）

Clinical diagnosis and treatment of hyperlipidemic acute pancreatitis：a report of 47 cases

目的 探讨高脂血症性胰腺炎的临床特点和治疗方法.方法 对我院2008年1月至2012年10月收治的47例高脂血症性胰腺炎的临床资料进行回顾性分析.血清甘油三酯（triglyceridemia,TG）浓度在5.65～11.3mmol/L之间伴有血清乳糜状者34例,血TG浓度≥11.3mmol/L者13例,重症急性胰腺炎者15例;43例采用胰岛素和血液滤过降脂、促进胃肠功能恢复、腹腔置管引流等非手术治疗,4例行手术治疗.结果 治愈43例,治愈率91.5%;死亡4例均为重症急性胰腺炎,随访1～2年,6例复发.结论 高脂血症性胰腺炎诊断上需结合血脂检测和影像学资料;治疗应以保守治疗为主,强调降脂治疗,外科干预应严格把握手术指征和时机.后期需坚持降脂治疗,防止复发.

Objective To investigate the clinical features and therapies of hyperlipidemic acute pancreatitis （AP）. Methods Clinical data of 47 cases of hyperlipidemie AP from January,2008 to Octo- ber,2012 were retrospectively analyzed. TG level ranged from 5.65 to ll. 3 mmol/L accompanied with chylous serum in 34 cases while it was higher than 11.3 mmol/L in 13 cases. Fifteen cases were classified into severe AP. Forty-three patients were given non-surgical therapy including administration of insulin and hemofihration to reduce plasma triglyceride, promotion of recovery of gastrointestinal function, and continu- ous drainage through intra-peritoneal catheterization. Four cases were treated operatively. Results Forty- three cases were cured（91.5% ）and 4 severe AP cases died. During 12 to 24 months＇follow-up 6 cases de- veloped recurrence. Conclusion Diagnosis of hyperlipidemic AP should be based on serum TG level and CT scanning. Non-surgical therapy is dominated and reducing serum TG is important in early period. Timing and indication should be strictly chosen for surgical intervention. Antihyperlipidemic drugs should be taken to prevent recurrence.