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頁籤選單縮合
題名 | Severe Colonic Complications in Acute Pancreatitis=急性胰臟炎之嚴重大腸併發症 |
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作 者 | 楊文固; 王聖賢; 李發耀; 趙毅; 陳俊嘉; 張扶陽; 姜仁惠; 蔡世豪; 蘇正熙; 楊宜寰; 李壽東; | 書刊名 | 中華醫學雜誌 |
卷期 | 61:2 1998.02[民87.02] |
頁次 | 頁59-64 |
分類號 | 416.248 |
關鍵詞 | 急性胰臟炎; 大腸併發症; 電腦斷層掃瞄; Acute pancreatitis; Colonic complication; Computed tomography; |
語文 | 英文(English) |
中文摘要 | 背景:急性胰臟炎合併大腸併發症可能很嚴重,但國人報告甚少。 方法:我們回顧1986年1月至1995年12月間,台北榮民總醫院1637位急性胰臟炎患者病歷,以發現具有嚴重大腸併發症之病例。進一步分析這些病例之臨床、放射線、病理學特徵及開刀之發現。 結果:1,637位急性胰臟炎患者中,有8名(0.55%)件有嚴重大腸併發症。其中6名之大腸併發症發生於急性胰臟炎後2-8週。8名患者之Ranson氏分數評估皆大於或等於3分。手術前有4名具明顯糞便潛血反應(含1名便血患者)。腹部電腦斷層掃瞄發現,所有病例皆有蜂窩織炎形成及大腸壁肥厚。8名患者中,有2名於手術前已由腹部電腦斷層正確診斷:包括l名為大腸皮膚間廔管,l名為大腸破裂。其餘6名則是手術中意外發現。所有患者之大腸侵犯部位都接近脾彎位置。所有患者都接受了壞死組織清除術及迴腸或結腸造口述,其中有3名患者還接受了大腸侵犯部位切除術,5名則接受大腸破裂處縫合術。8名中有3名(34%)因敗血症及多發性器官衰竭,於住院第44至122天間死亡。 結論:國人急性胰臟炎病患合併嚴重大腸併發症並不多見,手術前正確診斷更屬不易,腹部電腦斷層掃瞄對術前診斷或許有幫助。本分析顯示,當嚴重急性胰臟炎病患,於急性胰臟炎後2-8週內,併發下腸胃道出血,或明顯大便潛血反應,或腹部電腦斷層掃瞄發現大腸壁肥厚且有蜂窩織炎形成時,應高度懷疑大腸併發症,考慮儘早開刀治療。 |
英文摘要 | Background: Colonic complications in patients with acute pancreatitis may be very severe and have rarely been analyzed in Chinese patients. Methods: We retrospectively evaluated 1,637 patients with acute pancreatitis who were admitted to the Veterans General Hospital-Taipei from January 1986 to December 1995 in order to identify those with severe colonic complication. The clinical, radiologic and pathologic features and surgical findings in these patients are reviewed. Results: Eight of 1,637 patients with acute pancreatitis had severe colonic complications. Six of them were diagnosed between two and eight weeks after the onset of clinical pancreatitis. All had a Ranson's score of at least 3. Four patients, including one with hematochezia, had a strong positive reaction for occult blood in stool specimens. Computed tomography (CT) revealed necrotizing pancreatitis and colonic wall swelling in all eight patients. Colonic involvement was discovered by CT in two patients prior to surgery, one with colocutaneous fistula and the other with colonic perforation. The other six patients were found to have colonic involvement incidentally at the time of laparotomy. All of the colonic involvements were located near the splenic flexure. In addition to necrosectomy, three patients underwent segmental hemicolectomy and the remaining five patients had simple closure of the perforation. Diverting loop ileostomy or colostomy was also carried out in all patients. Three patients (34%) died of overwhelming sepsis superimposed on the subsequent multiple organ failure between 44and 122 days after the onset of pancreatitis. Conclusions: Severe colonic complications of acute pancreatitis are rare. Although preoperative diagnosis is difficult, CT may be helpful to make an early diagnosis. These complications should be suspected in patients with severe acute pancreatitis when acute lower gastrointestinal hemorrhage or positive stool occult blood is found two to eight weeks after the onset of pancreatitis or when CT reveals necrotizing pancreatitis and colonic wall swelling; this will allow early surgical intervention. |
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