感染性胰腺坏死并发腹腔及消化道出血的诊治

Diagnosis and treatment of infected pancreatic necrosis complicated with abdominal and gastrointestinal hemorrhage

出血是导致感染性胰腺坏死病人后期死亡的主要原因。在坏死性胰腺炎病程中,坏死范围局限包裹或不断蔓延扩大都将对周围器官血管形成侵袭压迫导致腹腔或消化道出血;而病人自身的凝血功能异常和手术干预等增加了出血风险。腹腔出血的常见类型包括假性动脉瘤破裂和囊肿内出血等;消化道出血的常见类型为急性胃黏膜病变和溃疡出血,胰源性门静脉高压出血和内镜支架相关出血等。临床医师应在多学科诊疗的基础上,根据病人病情变化趋势,出血部位、类型及时采取不同的治疗措施改善预后,保守治疗仅适用于出血少、生命体征稳定的病人,多数病人仍需及时行内镜、介入栓塞或手术干预治疗。

Hemorrhage is the main cause of late death in patients with infected pancreatic necrosis(IPN).In the course of necrotizing pancreatitis(NP),the necrotic area will be confined or spread and expand,both localized encapsulation and continuous spread of necrosis can invade and compress surrounding organs and blood vessels,leading to intra-abdominal or digestive bleeding.Additionally,Coagulation dysfunction of the patients and surgical intervention increase the risk of bleeding.Common types of intra-abdominal hemorrhage include pseudoaneurysm rupture,cyst hemorrhage,etc.while common types of gastrointestinal bleeding include acute gastric mucosal lesions,ulcer bleeding,pancreatic portal hypertensive bleeding and endoscopic stent-related bleeding.Clinicians should take different treatment measures to improve prognosis based on the patient's condition,bleeding site,and type,while also relying on multidisciplinary diagnosis and treatment.Conservative treatment is only suitable for patients with minor bleeding and stable vital signs,while most patients still need timely endoscopic,interventional embolization or surgical intervention.