【作者】 仝传志；

【导师】 王喜艳；

【作者基本信息】 新疆医科大学 ， 外科学， 2009， 硕士

【摘要】 目的:探讨重症急性胰腺炎相关性消化道瘘的病因、临床诊治特点,其目的提高SAP治愈率,降低消化道瘘并发症的发生率及病死率。方法:对2000年1月-2008年10月我院收治的14例SAP并发消化道瘘的临床资料进行回顾性分析,分析其发生的病因、发生部位、时间及对机体影响,并对其临床诊断和治疗进行总结。结果:本组14例中结肠瘘5例,占35.71% (5/14),十二指肠瘘6例,占42.86% (6/14),小肠瘘2例,占14.29% ( 2/14),胃瘘1例,占7.14% (1/14);消化道瘘发生的时间多在SAP发病4-16周内,14例均有胰外侵犯,其中有8例形成胰周脓肿;14例均经引流管造影确诊。本组治愈9例,治愈率为64.2%(9/14),3例因经济问题自行放弃治疗,2例因严重全身感染和继发多脏器功能衰竭而死亡。结论:SAP并发消化道瘘与解剖因素、胰外炎症的侵犯程度、手术治疗的时机选择和方法等相关,其中胰外炎症的侵犯程度是其发生的最主要因素;经引流管和瘘道造影检查是诊断消化道瘘的一种简便可靠的方法;治疗的重点在于建立充分有效的引流,同时积极维持内环境的稳定,维护重要脏器功能,加强营养支持治疗,有效控制感染。预防以控制SAP的发展以及胰周感染的发生为中心环节。更多还原

【Abstract】 Objective: To investigate the causes、diagnosis、measurement of the alimentary tract fistulas after severe acute pancreatitis(SAP), so as to increase its cure rate, decrease its case fatality rate. Methods: A retrospective study was made on 14 SAP cases compl- icated with alimentary tract fistulas to find out the risk factors, the location , the time and the effect to economy of complicated alimentary tract fistula, and to sum up the experien- ces of earlier diagnosis, comprehensive treatment. Results:Most patients occurred colo- nic fistulas 35.70 % (5/14) , duodenum fistulas 42.86% (6/14),small intestine fistulas 14.29% (2/14), stomach fistulas7.14%(1/14). Alimentary tract fistulas were found most in 4-16 weeks after SAP occurred, 14 cases all of them peripancreatic infection, 8 cases come in to been abscess. 14 cases were diagnosed by X- ray. nine cases recovered, the cure rate was 64.2%(9/14), three abandon the therapy and two died of serious systemtic infection and multiple organ systemtic failure. Conclusion:Alimentary tract fistulas complicated by SAP is related to anatomic factors, the degree of local inflameation and improper surgi- cal therapy, the most important is local inflameation . X- ray is a way of safty and credibility in diagnosis. The emphases of therapy is draingage in active, keep economy stabilization, protect vitals, strengthen nutriation suppor, control infects . The center of prevent tache is actively control SAP development and peripancreatic infection.更多还原