阳　凤　彭　燕

西南医科大学附属医院消化内科(646000)



重度急性胰腺炎并发胰腺脓肿的诊治进展

阳凤彭燕*

西南医科大学附属医院消化内科(646000)

摘要胰腺脓肿(PA)是重度急性胰腺炎(SAP)最严重的并发症，可导致全身和(或)局部并发症，甚至死亡。PA形成后无法自行消除，一旦诊断成立，应早期通畅引流、抗感染、加强营养支持等治疗，其中通畅引流尤为重要。以往PA的治疗以手术治疗为主，随着微创技术的发展，内镜超声(EUS)引导下引流以及经皮穿刺置管引流(PCD)为PA的治疗开辟了新途径。对于SAP患者，预防和早期诊断PA成为治疗中的挑战之一。本文就SAP并发PA的诊治进展作一综述。

关键词胰腺；脓肿；胰腺炎；诊断；治疗

Progress in Diagnosis and Treatment of Severe Acute Pancreatitis Complicated with Pancreatic Abscess

YANGFeng,PENGYan.

DepartmentofGastroenterology,theAffiliatedHospitalofSouthwestMedicalUniversity,Luzhou,SichuanProvince(646000)

Correspondence to: PENG Yan, Email: 1806857826@qq.com

AbstractPancreatic abscess (PA) is the most serious complication of severe acute pancreatitis (SAP), which can lead to systemic and/or local complications, and even death. PA cannot be resolved automatically after the formation. Once diagnosed, early drainage, anti-infection and nutrition support should be undertaken, the most important is early drainage. In the past, the treatment of PA was mainly based on surgical treatment. With the development of minimally invasive techniques, endoscopic ultrasound (EUS) guided drainage and percutaneous catheter drainage (PCD) offer a new way for the treatment of PA. Preventing and early diagnosis of PA become a challenge in the treatment of SAP. This article reviewed the progress in diagnosis and treatment of SAP complicated with PA.

Key wordsPancreas;Abscess;Pancreatitis;Diagnosis;Therapy

胰腺脓肿(pancreatic abscess, PA)是重度急性胰腺炎(severe acute pancreatitis, SAP)最严重的并发症，发生率约为5%[1]，病死率国外为14%～54%[2]，国内为12.2%～25%[3]。通常发生于急性胰腺炎(AP)病程后期(距发病4～6周)，多数情况下由局灶性坏死液化继发感染形成[4-5]。如未及时干预，可导致全身和(或)局部并发症，甚至死亡。本文就SAP并发PA的诊治进展作一综述。

一、诊断

1. 临床诊断：PA患者的临床表现各异，感染征象是常见的临床表现。SAP患者如出现败血症表现，而无其他原因可寻(尤其是疾病进展至第4～6周)，高度提示PA。患者表现为症状和体征发生改变和加剧，如发热、持续性心动过速、呼吸加快、胃肠道症状、肠麻痹、腹痛加剧，白细胞计数升高、肝肾功能异常等。体格检查显示上腹部或全腹压痛，可触及包块，腹部痛性包块是PA最具价值的诊断体征[6]。

2. 影像学检查：B超可显示PA大小、数目和位置。……