胰瘘：临床表现及诊断
- Authors
- Santhi Swaroop Vege, MD
Santhi Swaroop Vege, MD
- Professor of Medicine
- Mayo Clinic
- Michael L Kendrick, MD
Michael L Kendrick, MD
- Associate Professor of Surgery
- Mayo Clinic College of Medicine
- Section Editors
- David C Whitcomb, MD, PhD
David C Whitcomb, MD, PhD
- Section Editor — Pancreatic Diseases
- Professor of Medicine
- University of Pittsburgh School of Medicine
- Stanley W Ashley, MD
Stanley W Ashley, MD
- Section Editor — Pancreatic and Hepatobiliary Surgery
- Chief Medical Officer and Senior Vice President for Clinical Affairs
- Brigham and Women’s Hospital
- Frank Sawyer Professor of Surgery
- Harvard Medical School
- Deputy Editor
- Shilpa Grover, MD, MPH, AGAF
Shilpa Grover, MD, MPH, AGAF
- Deputy Editor — Gastroenterology/Hepatology
- Assistant Professor of Medicine, Part-time
- Harvard Medical School
- Translators
- 刘枫, 副主任医师，副教授
刘枫, 副主任医师，副教授
- 第二军医大学附属长海医院消化内科
引言
胰瘘以胰管破裂引起胰液外漏为特征。胰管破裂可发生于急性或慢性胰腺炎、胰腺切除或创伤后。由于营养不良、皮肤破损和感染，胰腺分泌物的漏出可引起严重的并发症。
胰瘘的流行病学、发病机制、临床特征和诊断将总结在此。胰瘘的预防和处理将单独详细讨论。 (参见“胰头病变的外科切除术”，关于‘预防’一节和“胰体和胰尾病变的外科切除术”，关于‘术后胰瘘’一节和“胰瘘的处理”)
定义和分类
胰瘘定义为胰腺与邻近或远处器官、结构和腔隙的异常相通。
胰瘘分为内瘘和外瘘，内瘘是指胰管与腹膜腔、胸膜腔或其他空腔脏器相通；外瘘是指胰管与皮肤相通。胰瘘也可根据基础疾病过程和直接诱因进行分类(表 1)。
根据国际胰瘘研究小组(International Study Group for Pancreatic Fistulas, ISGPF)的定义，术后胰瘘是指手术3日后，任意可测量到的引流量并伴有引流液淀粉酶水平超过正常血清值上限3倍的一种胰外瘘[1]。基于胰瘘对患者住院治疗过程和结局的临床影响，将术后胰瘘按照以下分级(表 2)(参见下文‘临床表现’)：
Subscribers log in here
To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:Literature review current through: 2017-06 . | This topic last updated: 2016-06-15.The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.References- Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005; 138:8.
- Bassi C, Butturini G, Molinari E, et al. Pancreatic fistula rate after pancreatic resection. The importance of definitions. Dig Surg 2004; 21:54.
- Alexakis N, Sutton R, Neoptolemos JP. Surgical treatment of pancreatic fistula. Dig Surg 2004; 21:262.
- Yeo CJ, Cameron JL, Lillemoe KD, et al. Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial. Ann Surg 2000; 232:419.
- Muscari F, Suc B, Kirzin S, et al. Risk factors for mortality and intra-abdominal complications after pancreatoduodenectomy: multivariate analysis in 300 patients. Surgery 2006; 139:591.
- Ho HS, Frey CF. Gastrointestinal and pancreatic complications associated with severe pancreatitis. Arch Surg 1995; 130:817.
- Tsiotos GG, Smith CD, Sarr MG. Incidence and management of pancreatic and enteric fistulas after surgical management of severe necrotizing pancreatitis. Arch Surg 1995; 130:48.
- Connor S, Ghaneh P, Raraty M, et al. Increasing age and APACHE II scores are the main determinants of outcome from pancreatic necrosectomy. Br J Surg 2003; 90:1542.
- Kaman L, Behera A, Singh R, Katariya RN. Internal pancreatic fistulas with pancreatic ascites and pancreatic pleural effusions: recognition and management. ANZ J Surg 2001; 71:221.
- Ban D, Shimada K, Konishi M, et al. Stapler and nonstapler closure of the pancreatic remnant after distal pancreatectomy: multicenter retrospective analysis of 388 patients. World J Surg 2012; 36:1866.
- Fulcher AS, Capps GW, Turner MA. Thoracopancreatic fistula: clinical and imaging findings. J Comput Assist Tomogr 1999; 23:181.
- Lawrence C, Howell DA, Stefan AM, et al. Disconnected pancreatic tail syndrome: potential for endoscopic therapy and results of long-term follow-up. Gastrointest Endosc 2008; 67:673.
- Pelaez-Luna M, Vege SS, Petersen BT, et al. Disconnected pancreatic duct syndrome in severe acute pancreatitis: clinical and imaging characteristics and outcomes in a cohort of 31 cases. Gastrointest Endosc 2008; 68:91.
- Barkin JS, Ferstenberg RM, Panullo W, et al. Endoscopic retrograde cholangiopancreatography in pancreatic trauma. Gastrointest Endosc 1988; 34:102.
- Ceroni M, Galindo J, Guerra JF, et al. Amylase level in drains after pancreatoduodenectomy as a predictor of clinically significant pancreatic fistula. Pancreas 2014; 43:462.
- Devière J, Bueso H, Baize M, et al. Complete disruption of the main pancreatic duct: endoscopic management. Gastrointest Endosc 1995; 42:445.
- Bradley EL 3rd, Young PR Jr, Chang MC, et al. Diagnosis and initial management of blunt pancreatic trauma: guidelines from a multiinstitutional review. Ann Surg 1998; 227:861.
- Fulcher AS, Turner MA, Yelon JA, et al. Magnetic resonance cholangiopancreatography (MRCP) in the assessment of pancreatic duct trauma and its sequelae: preliminary findings. J Trauma 2000; 48:1001.
- Soto JA, Alvarez O, Múnera F, et al. Traumatic disruption of the pancreatic duct: diagnosis with MR pancreatography. AJR Am J Roentgenol 2001; 176:175.
- Ragozzino A, Manfredi R, Scaglione M, et al. The use of MRCP in the detection of pancreatic injuries after blunt trauma. Emerg Radiol 2003; 10:14.
- Cappeliez O, Delhaye M, Devière J, et al. Chronic pancreatitis: evaluation of pancreatic exocrine function with MR pancreatography after secretin stimulation. Radiology 2000; 215:358.
Top