胰腺坏死组织感染合并腹腔出血的诊治

Diagnosis and treatment of infected pancreatic necrosis with abdominal hemorrhage

腹腔出血是胰腺坏死组织感染(IPN)最严重的并发症之一。常见的出血原因包括动脉源性、静脉源性、凝血功能异常相关性及医源性。IPN合并腹腔出血的首选治疗方法是数字减影血管造影(DSA)和经导管动脉栓塞。对于反复DSA阴性、保守治疗无效或急性出血、生命体征极不平稳的患者,需要急诊手术。手术应遵循损伤控制原则。如何预防IPN患者出血是未来工作的重中之重。本文结合笔者所在团队诊疗经验以及相关研究报道,就IPN合并腹腔出血的诊治与同行交流探讨。

Abdominal hemorrhage is one of the most severe complications of infected pancreatic necrosis(IPN).Common causes of bleeding include arterial,venous,coagulopathy-related,and iatrogenic factors.The preferred treatment for IPN complicated by abdominal bleeding is digital subtraction angiography(DSA)combined with transcatheter arterial embolization.For patients with repeated negative DSA results,ineffective conservative treatment,or acute bleeding with extremely unstable vital signs,emergency surgery is required.The surgery should follow the principles of damage control.Preventing bleeding in IPN patients is a top priority for future work.This article,based on the diagnostic and treatment experience of the authors'team as well as relevant research findings,shares thoughts and discusses with fellow professionals regarding the diagnosis and treatment of IPN with abdominal hemorrhage.