急性胰腺炎相关性肝门静脉积气2例报告并文献复习

Hepatic portal venous gas associated with pancreatitis: a report of two cases and literature review

目的:总结急性胰腺炎相关性肝门静脉积气(HPVG)的临床特征、发病机理、治疗及预后。方法:回顾性分析收治并诊断为急性胰腺炎相关性HPVG的2例患者的临床资料并进行相关文献复习与讨论。结果:病例1,男性,65岁,因腹痛10d入院,诊断为急性胆源性胰腺炎,入院时CT未显示HPVG,病程中腹胀加重并于入院1个月后出现感染性休克表现,复查腹部CT提示HPVG、胰腺内及胰腺周围大量坏死组织包裹,保守治疗3d后因症状仍进行性加重而自动出院,出院1周后死亡。病例2,女性,70岁,腹痛1d入院,入院时即表现为感染性休克,入院CT提示胰腺炎、HPVG伴腹膜后散在积气,当日急诊行腹腔镜探查+中转开腹胰腺被膜切开减压+腹腔引流术,术后休克持续加重并出现多脏器功能不全不能纠正,于术后4d自动出院并于当日死亡。既往文献报道胰腺炎相关性HPVG11例,临床主要表现为腹痛,诊断主要依赖B超和CT检查,其中6例死亡,5例存活。结论:胰腺炎相关性HPVG发病率低,但常合并肠管缺血坏死,病死率较高,应该在保守无效后积极进行手术干预。

Objective:To summarize the clinical features,pathogenesis,diagnosis and treatment as well as prognosis of hepatic portal venous gas (HPVG) associated with pancreatitis.Methods:The clinical data of 2 patients admitted and diagnosed as HPVG associated with acute pancreatitis were retrospectively analyzed.The relevant literature was reviewed and discussed.Results:Case 1 was a male patient,65 years of age,who was admitted due to abdominal pain for 10 d and then diagnosed as acute biliary pancreatitis.Abdominal CT did not show HPVG on admission.In this patient,the abdominal distension aggravated during the progress of the disease and signs of septic shock appeared one month after admission;abdominal CT reexamination showed HPVG and a large amount of walled-off necrotic debris in the pancreas and peripancreatic region.The patient was discharged on his own request because of progressive deterioration after 3-d conservative treatment,and died one week after discharge.Case 2 was a 70-year old woman who was admitted for severe abdominal pain for 1 d,and presented with septic shock on admission.CT showed pancreatitis with HPVG and scattered gas collections in the retroperitoneal space.Emergency laparoscopic exploration and converted open incision of the pancreatic capsule for decompression plus abdominal drainage were performed.The situation continued to deteriorate and multiple organ dysfunction could not be corrected after operation.The patient was discharged on her own request 4 d after operation and died on the same day.There were 11 cases of HPVG associated with acute pancreatitis reported by previous literature,of whom,the main manifestation was abdominal pain,and diagnosis of the disease was mainly dependent on CT and B ultrasound,6 cases died and 5 cases survived.Conclusion:HPVG associated with acute pancreatitis is a rare condition,but it is always complicated with intestinal ischemia and necrosis,and results in a high mortality rate.Aggressive surgical management should be performed if conservative treatment fails.