急性胰腺炎网膜囊坏死物破溃综合征的临床特征和诊疗策略

The clinical features and treatment strategies of omental sac necrosis rupture syndrome in acute pancreatitis

急性胰腺炎网膜囊坏死物破溃综合征(OSNRS)是一种特殊类型的急性坏死物积聚,其特征是坏死物主要积聚于网膜囊,随病程进展,其范围逐渐扩大、压力进行性升高,若不积极干预,在进展为包裹性坏死或感染性坏死前,网膜囊坏死物就可能经网膜囊前壁(主要是胃结肠韧带)破溃入腹膜腔,导致急性腹膜炎、多器官功能障碍,危及生命。诊断依据腹部增强CT的2个特征性表现——横结肠系膜受侵犯及网膜囊内坏死物蔓延至结肠肝区外侧。继发并发症还包括早期自发性出血,结肠狭窄、梗阻及缺血、坏死,胆囊缺血、坏疽,门静脉系统血栓等。一旦诊断为OSNRS,应严密动态监测腹部CT,根据病变进展情况决定干预时机,干预方式建议首选经皮穿刺置管引流。

Omental sac necrsis rupture syndrome(OSNRS)is a special type of acute necrotic collection(ANC)in acute pancreatitis(AP),which is characterized by the accumulation of necrosis in the omental sac.With the progression of the disease,the scope of OSNRS will gradually expand and the pressure will gradually increase.Without active intervention,before it progresses to walled-off necrosis or infected pancreatic necrosis,the omental sac necrosis may break through the anterior wall of the omental sac(mainly through the gastrocolic ligament)into the peritoneal cavity,leading to acute peritonitis,multiple organ dysfunction,which is life-threatening.The diagnosis of OSARS mainly relies on two characteristic features of abdominal enhanced CT—transverse mesocolic invasion and omental sac necrosis spreading to the lateral hepatic region of the colon.The secondary complications include early spontaneous hemorrhage,colonic stenosis,obstruction,ischemia,necrosis,gallbladder gangrene and ischemia,portal venous system thrombosis,etc.Once diagnosed OSNRS,abdominal CT should be monitored closely and dynamically,and the timing of intervention should be determined according to the progression of the lesion.Percutaneous catheter drainage is recommended as the first choice for intervention.