先天性心脏病术后肠梗阻并发急性胰腺炎1例.docVIP

先天性心脏病术后肠梗阻并发急性胰腺炎1例 　　[摘要] 术后肠梗阻并发急性胰腺炎在临床上非常少见，肠梗阻和胰腺炎均为临床常见急腹症，两者互为关联，一般急性胰腺炎导致肠梗阻临床较为多见，而急性重症肠梗阻导致急性胰腺炎发作临床报道甚少，笔者联合阜外心脏中心专家就本例心脏术后肠梗阻致急性胰腺炎做相关报道。 　　[关键词] 肠梗阻；急性胰腺炎；淀粉酶 　　[中图分类号] R656.7 [文献标识码] B [文章编号] 1673-9701（2013）36-0123-02 　　1 case of intestinal obstruction and acute pancreatitis after surgery for congenital heart disease 　　XU Guixiang1 YING Hao1 WANG Zhenxu1 ZHOU Shilong1 WU Yongming1 XUE Guoliang2 XU Jingyong3 XUE Bingchuan4 　　1.Surgery， Qingdao Fuwai Hospital Qingdao 266034，China；2. Department of Cancer， Jinan Military General Hospital，Jinan 250031，China；3.Department of surgery， Ministry of Health Beijing Hospital，Beijing 100730，China；4.Department of surgery， the Third Clinical Medical College of Shanxi Medical University，Taiyuan 030053，China 　　[Abstract] Intestinal obstruction and acute pancreatitis after surgery for congenital heart disease is very rare. Intestinal obstruction and acute pancreatitis are clinical common acute abdominal pain，the two are related to each other.Generally speaking， the acute pancreatitis causing intestinal obstruction is relatively common，however the severe intestinal obstruction causing acute pancreatitis is rarely reported.The author combined heart experts for the purpose of this case in the fuwai heart center of 1 case of intestinal obstruction and acute pancreatitis after surgery for congenital heart disease do the report. 　　[Key words] Intestinal obstruction；Acute pancreatitis；Amylase 　　术后肠梗阻并发急性胰腺炎患者在临床上并不多见，现将我院收治的1例先天性心脏病手术治疗后出现肠梗阻并发急性胰腺炎报道如下。 　　1临床资料 　　患者男，16岁，因“先天性心脏病、部分性肺静脉异位引流、房间隔缺损、肺动脉高压”入院，排除手术禁忌证，在全身静脉复合麻醉经体外循环下行“部分肺静脉异位引流矫治术+三尖瓣成形术”，手术过程顺利，术后第3天患者出现腹胀、腹痛、恶心、呕吐，呕吐物为胃内容物，未排气、排便，腹部CT所示胰腺未见明显异常，如图1，胃肠腔扩张其内积存大量液体，如图2、3。查体：中上腹部压痛，无明显反跳痛，肠鸣音活跃，给予开塞露灌肠，排除少量大便，给予：①禁食、胃肠减压；②抑制胃酸、胰腺分泌药物；③补液、胃肠外营养（TPN）支持；④抗生素治疗；⑤加强重要脏器功能的监护和支持。胃肠减压管引流出液体量约1500mL，血淀粉酶为259U/L。术后第8天，患者血淀粉酶为232U/L，复查上腹部CT示：胰腺略大，未见明显异常密度灶，如图4；经过积极治疗，患者肠梗阻解除，排气、解大便，腹部无明显疼痛，无发热，复查血常规、肝肾功无异常，血尿淀粉酶在正常范围内，再次复查CT胰腺无异常，患者治愈出院。 　　图1 胃、十二指肠扩张其内积存大量液体，